Q&A: #109

Living Alternatives
By Carol Abaya, M.A.

Question:  My mother can no longer be taken care of at home, and we have been looking at nursing homes.  We would pay for the care and fees.  The homes in our area with the best reputation want us to turn over all of my mother’s assets to them.  After we sell her house, she’ll have about $200,000.  What happens to all that money if we give it to the home and my mother dies in the next several years?

Answer:  Never ever turn over assets to a nursing home or other health care facility!  As private pay, you should retain control of your mother’s money and pay the nursing home bills as they come in. 

While the homes you speak of may have a good reputation for care, what they are doing is illegal.  Under Federal law, nursing homes cannot require a large up front fee or asset turnover as a condition for admittance.  Such demands are a crime!  These homes should be reported to HCFA and your state nursing home licensing agency.

Question:  My mother is in an assisted living home.  She loves to get dressed up and insists on putting on earrings and a pin every day even though she’s not going anywhere.  She keeps losing one earring and lately misplacing pins.  Some were very expensive.  Then she gets very upset and has started accusing the housekeeper of stealing them.  How can we handle this?

Answer:  Dressing up with earrings and a pin makes your mother feel good about herself at a time when she is losing abilities to take total care of herself.  Self-esteem is very important to the elderly.  So, you need to encourage her to continue “looking nice.”

Losing only one earring is common, regardless of age.  And if you’ve really liked them, it’s hard to lose one.

First, expensive jewelry should not be kept when a person is in a ALF or SNF.  You should keep the costly items at home and enable her to wear them on special occasions and holidays.

Second, take her shopping and let her choose some inexpensive earrings and pins that she likes (under $5 or $10, if funds are limited and loss is very often).

Perhaps without her knowing it, buy a second pair of the same earrings or pin.  Then when she loses one, you can replace it, saying, “Oh, here it is.  You must have dropped it on the floor.”

This will diffuse an emotional situation.

Question:  My mother has been in a nursing home for two years, and recently has complained that staff is stealing her money.  The latest loss is $60.  I send her $150 on the first of every month for spending money.  How can we stop this stealing?

Answer:  It is very difficult to substantiate that the staff in a facility is stealing.  It may be that your mother has “hidden” it and can’t remember where she put it.  At the same time, if staff knows she gets a sizable check each month, they can be tempted.

To reduce the temptation to steal, send the check to the facility business office and make arrangements for them to give her money every week.  Or a larger amount when she wants to make a special purchase.  Have her keep track of what she spends in a notebook.

An alternate would be to have her lock her money in a desk or dresser drawer or jewelry or metal file box.  Make sure you have duplicate keys.

Question:  My mother, 82, recently moved into an assisted living home, and constantly complains about being bored.  We’re paying good money so she can take advantage of activities.  We don’t like to complain, but ......

Answer:  You’re not “complaining” when you ask the home administrator or manager how your mother is doing.  Is she making new friends?  Is she participating in activities?  How do they think she’s adjusting.

You’re establishing a dialogue with the staff.  Such on-going dialogues are important.  If your mother really isn’t participating, then staff can encourage her more and help her make the adjustment.

Do keep in mind, that she may be participating in various activities.

One administrator I’ve known for years was confronted by an enraged daughter that her mother wasn’t leaving her room.  The administrator was surprised as the woman was at every event.  She even had pictures showing the mother, in a happy frame of mind.

Often elders, who have moved into an assisted living unit, are unhappy.  They’ve been moved from a familiar environment in which they had complete control over their daily activities.  Now they’re in a strange place surrounded by strangers.  Adjustments do have to be made.  Give her more time - see how she does after six months.

Try to find out what activities are scheduled ahead of a visit.  Asking her  “What did you do this week?” leaves it open for a negative response “nothing.”  But if you say, “I understand there was a fabulous dance group here the other day.  Did you enjoy it?”  This is a positive approach, and you are more likely to get a positive response.

If she still has friends in the community, encourage her - and her friends - to keep in touch and to continue doing things together.

Question: I am a social worker at a community hospital.  I see too may people kept in the hospital to die when they would prefer to be home and could be kept just as comfortable there as here.  I talk to the families and suggest hospice, but too often the dying are left alone to die in the hospital.  I know family members can’t stay here 24 hours a day, but the dying person feels deserted.  What can I do?

Answer:  You are right in saying many can be kept at home just as comfortably physically, and more comfortably emotionally.  It is a big responsibility on the part of the family.  Understanding what hospice is can go a long way in encouraging families to participate.  While it certainly is a very sad time, it can also be very rewarding.  One woman, whose father was never affectionate or demonstrative, said to me “I was able to give him all my love during those last few days, something I hadn’t been able to give earlier.”

Hospice is a service for the terminally ill, for those diagnosed to have about six months or less to live, who do not wish to prolong their lives by extraordinary means, and want to remain at home.  A multi-faceted team approach allows people to die at home with dignity, in familiar surroundings with loved ones around them.

In her book “Caring for Life and Death,”  Nelda Samarel says “The individual is viewed as a three-dimensional being: biological, psychological and spiritual.  Hospice focuses on the psychological and spiritual, while permitting the biological process to follow its natural course.”

Hospice programs also help family members care for their loved one and cope with the emotional strain of see a loved one suffer.

The dictionary definition of hospice is “a house of shelter or rest.”  Its history and development to today’s care for the dying is interesting.

In medieval times, hospices sat on well-traveled roads and provided shelter for pilgrims, usually on their way to religious shrines.  They were going from one place to another.

In modern times, the dying person is viewed as a traveler moving forward as death is viewed as a transformation.

Thus the objective of hospice is to help dying people “travel” in comfort during their last days.

In 1978 the need for formalized hospice care was recognized, and the National Hospice Organization established.  Both professionals working in hospice as well as thousands of volunteers are specially trained to provide both physical and emotional support to the dying and their families.

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