Mom is very happy at her nursing home -- so it is possible.

[pnwmom]

Last edited Sat May 27, 2017, 09:06 PM - Edit history (2)

For a year and a half she's been in a nursing home we found when she could no longer live at home.

It accepts Medicaid as full payment, and about 70% of the people there are on Medicaid. The private pay people pay A LOT. But if they run out of money, they can transition to Medicaid. So we didn't worry about how much it cost, because we knew when her money ran out she'd be okay.

All the rooms are private, with private bathrooms, so Medicaid people are just as comfortable as private pay. They don't change rooms or anything else when they switch to Medicaid funding. The home is a non-profit run on something called the "Greenhouse model."

I think that the 3 main things that make Mom happy (besides my sister's family being close by, and their frequent visiting):

1) pleasant staff, with very good caretaker/elder ratio;
2) the private rooms
3) Mom can have the ice cream she wants, when she wants it. They keep a store of it in the freezer with her name on it.

It's funny how much the little things matter -- like ice cream -- but they do. If you're looking for a nursing home for a loved one, a good sign is if they're flexible about the little things.

ON EDIT: Her nursing home was based on something called "The Greenhouse Project" -- a design for nursing homes that different nursing homes practice across the country. More here:

http://www.thegreenhouseproject.org/

Greenhouse homes by state:

http://www.thegreenhouseproject.org/about/find-a-home

[samnsara]

1. can you set up a security cam in her room?....

...there are so many abuses in nursing homes. My parents are one step below assisted living.. they are in their own home but they are high fall risks. I have a camera set up in their living room and actually saw my father fall. You can talk thru the cameras to let them know you are there. See if this is an option. We use Foscam and we can see them from our phone 24-7.

[kstewart33]

2. Very good to know. Thanks for posting. nt

[pnwmom]

4. I think we probably could. But Mom is still quite capable of complaining

if she doesn't like her care! So that this point I'm not worried about abuse.

She did slip once, getting herself into her wheelchair, and they came quickly to help her. (Her room door is open to the hall during the day, and usually a staffer is nearby. There are only 10 elder rooms arranged around the common areas, and three caregivers assigned to them.) But I'll ask my sister about the possibility of a cam.

Thanks for the idea!

[samnsara]

3. you can also speak thru them....

[Archae]

5. My Mom moved into assisited living little less than a year ago.

She can still walk, and drive.

In fact as I write this, she's visiting old friends near her previous home, (the house is for sale,) in northern WI.

She does fine, yes, she does miss having her own home, but she just couldn't afford it.

Mom is in her early 80's, and we see her quit often.

I was just with her on Thursday.

[JNelson6563]

6. It can work great for some!

I do not see it as a desirable option for me at any point but it is for some and I am glad of that!

[Freddie]

7. Count your blessings

9 years ago Mom had a stroke and Dad, then 87, couldn't take care of her and the house anymore. We persuaded them to move to a really nice and highly recommended assisted living place.
Mom adjusted fine and I think she was comforted by the fact that help was availabile 24/7, and the staff loved her. Dad complained for 6+ years about the food, the staff, the other residents, etc. He was always a real "take charge" guy and could never accept that he couldn't live on his own anymore. They're both gone now. I know they were well cared for but Dad's attitude made me feel horrible about the whole thing.

[pnwmom]

16. Oh, believe me, I do.

I'm also extremely grateful to my siblings for all agreeing to the "best nursing home nearby" plan -- with the decision based on finding the best home, no matter who it was near.

[Dem_4_Life]

8. Wow that sounds nice! What state are in?

Here in Texas the nursing homes are not that nice at all and we are the state with the highest % of elder abuse...go figure

That sounds like a fantastic place and your mom sounds a lot like my grandparents and their friends.....Don't ever mess with the ice cream haha

[pnwmom]

10. She left Texas. She'd had two broken hips there (at two different times)

and her nursing/rehab home experience was NOT GOOD. That's when we learned that Texas ranks about 48 or 49 in the nation. So when she was ready to be discharged from her rehab stay, we looked outside Texas. My siblings and I live in different states so that gave us some options. We decided that Mom would go to the sibling who had the nicest nursing home nearby.

She's in Ohio now, in a non-profit run by the Methodists. And the non-profit part seems to be key.

Apparently Texas now has a couple nursing homes based on the model of the home Mom is in. You could look here.

http://www.thegreenhouseproject.org/about/find-a-home

[Dem_4_Life]

29. She's so lucky to have such great kids.

Even though my family is all in Texas my grandparents were lucky after their horrible rehab/nursing home experiences to be able to end up living in a fantastic independent living senior living apartment. They were able to reside there for years before they both ended up in hospice and were fortunate enough not to suffer with horrible illnesses for long before passing. My grandpa actually went to the hospital on inauguration day and in our opinion Trump didn't help him. He passed shortly after at the end of February. My grandpa came from a political family and he was a very political man his whole life. His cousin was a congressman who has a federal courthouse named after him. My grandpa was investment banking CEO and worked with daddy Bush before the Reagan years. He always was very middle of the road politically until GWB went to Iraq. He was so deeply disturbed by Trump that it seems like he just gave up trying. But I know he is proud of all the resistance since that's what he would have done in his younger days.

Long story short... Thanks for the link I'm going to pass it on to some friends. That helps tremendously. I'm so happy for your mom and your family that she's in a great place.

[Akoto]

9. My grandmother did very well in assisted living.

It wasn't her house, but she adapted over time and eventually became involved in the community activities going on in the home. Strangely enough, she also had a thing for having ice cream on hand! She always was addicted to the stuff.

Unfortunately, she fell and broke her hip a second time, and she had to be moved to an actual nursing home until her passing. That was less pleasant, but it was a freak accident. She always had great care and supervision in assisted living.

I'm glad to hear that your mom is doing well! It makes a difference when the circumstances feel like you still have some independence, I think, speaking as a disabled person.

[pnwmom]

12. So did my mother in law.

And she could stay there till the end.

Mom could have gone to the highest level of care at an assisted living place, but if she stayed there till she ran out of money, she'd have fewer choices when it came to getting into a nice nursing home. (Your choices are limited to whatever nursing home has a Medicaid opening when you happen to need it.)

If a person is eligible either for the highest-level care at assisted living or a nursing home, they might be better off going to the best nursing home they can find, as a private pay patient. Later, they can switch to Medicaid, if they outlive their savings.

Yes -- feeling independent and having choices makes a great deal of difference in how you feel about any of these homes. They treat Mom like an adult there, with choices. And that makes a huge difference.

[Binkie The Clown]

11. Glad that's working out for her.

My mom can't take care of herself anymore, so now she's living with me. I've been living alone for 6 years since my wife passed, so I'm having to adjust to having someone else in the house again. I just hope I can give her the help she needs. She is really against the idea of a nursing home.

[pnwmom]

14. Theoretically, Mom didn't like the idea, either. But it turns out

she's happier now than she was before. She has more company, for one thing. And because of the private room, she can have privacy when she wants, too.

There are more and more nursing homes around the country that are following the personalized model that Mom's home follows. Here's site that talks about it.

http://www.thegreenhouseproject.org/

[Binkie The Clown]

20. Thanks for the link. n/t

[luvMIdog]

13. The people who get the best care in nursing homes are the ones whose family visits very very often

sad but true.

[pnwmom]

15. And also the ones with excellent caregiver/elder ratios. n/t

[CountAllVotes]

44. True

My late mother was in a care home at the end of her life (long story).

I would go to visit her and when they knew I was coming, they'd clean the place up.

What they failed to do was hide the bottled water I'd been hauling into the place FOR HER. It was being given to the other people that were there!

This care home attempted to manipulate her will before she died, leaving them a tidy sum of $.

Buyer beware I suppose!

[luvMIdog]

17. yes & I would also like to ask them to prove to me they run background checks on staff

[cwydro]

18. My mother swore that we should kill her before ever letting that happen to her.

She died at home, which is what she wanted.

Good luck with this. Be very VERY vigilant.

Unfortunately, I know too many bad stories about all of these places. I wish you luck.

Ice cream is really not the most important thing to worry about, sadly, though perhaps it should be.

[pnwmom]

21. Ice cream in her mind stands for independence and individuality.

They believe in letting the elders make as many decisions for themselves as possible (including when to get up, when to go to bed, and when to have a snack). Another example is she's always loved having peanut butter and jelly sandwich for lunch -- so that's what she usually has, no matter what they're making for everyone else. And she's fine with it, her doctor's fine with it, and everybody's happy.

[justgamma]

19. My Grandma loved her nursing home.

There was always a card game going. She put 1000 pc. puzzles together. She was always busy. Her roommate was a yeller. I asked Grandma why didn't that bother her. She just grinned and said "I just turn my hearing aid off." She passed away at age 98, 30 years ago and I still miss her every day.

[Dem_4_Life]

32. Aww is that where your username came from.

Your grandma sounded like she was a great woman with a fantastic attitude and personality.

[annabanana]

22. My Mother is in a graduated assisted living community. Many of the programs

were suggested by, and are RUN by residents. They have much more agency than in other places I've seen. They bring in lecturers, do little theater, etc.
She' very happy with it.

[left-of-center2012]

23. None in New Mexico

And the states I checked via your link only have one each.

Those on Medicaid are blessed. It pays all their medical bills, prescriptions, dental, eye glasses.

But someone like me who gets about $13,000 a year on Social Security makes too much money to qualify for Medicaid.
I get Medicare, which only pays 80% of my healthcare, but no dental or eye glasses.
And I pay $50 per visit each time I see one of my five "specialists".

My doctor told me a week ago I have "vascular dementia".
He wants me to have an MRI which has a copay I'd pay of $300.

And what happens to me if/when I need a nursing home?

I'm glad there are good nursing homes.
I'm glad Medicaid folks don't have to pay anything.

But my personal situation had me wondering the other day if there are any states in which they have doctor assisted suicide for dementia patients.

[pnwmom]

26. Mom gets about the same amount you do from Social Security and it's not too much

to qualify for a Medicaid-accepting nursing home. So if that's your only income, you should qualify, too.

Her Social Security payment goes to the nursing home (I think there's $50 a month that she can use for personal expenses); and Medicaid pays the nursing home the balance of the cost. (The nursing home charges the state less for Medicaid patients than it charges to private -pay people with financial assets.)

[left-of-center2012]

40. I only know ...

When it comes to health care, doctors, etc as an 'out patient' I do not qualify for N.M.'s medicaid.

(Likewise my income qualifies me for about $22 a month in food stamps)

I had envisioned spending my senior years traveling the USA in a VW bus camper ala my hippie days.

[pnwmom]

41. Here are the 2017 rules. People who have no more than $2,000 in assets

and monthly income below $2205 qualify for Medicaid nursing home coverage.

Of course, the new administration wants to wreck the whole system, so who knows what will happen in the future. But if you needed it today, and were Medicare age, and were under those income/asset limits, you would qualify.

https://www.familyassets.com/resources/state-medicaid-rules/new-mexico

Asset Limits in New Mexico For Medicaid
Individuals in New Mexico are allowed to keep $2,000 when they apply to Medicaid for long term care. If they are over this amount, they must spend down on care. It is important to note, that individuals are not allowed to give gifts of any amount for a period of 5 years (60 months) prior to applying to Medicaid. If an individual's assets are more than $2,000, they should learn about Medicaid Planning strategies. This asset limit only applies to assets that are considered countable assets.

If there is one spouse that requires care, and one that does not, the spouse that does not receive care is referred to as the Community Spouse. The Community spouse is allowed to keep 50% of their assets up to $120,900 in countable assets. The Community Spouse is allowed to keep 100% of their marital assets up to $31,290.

The maximum amount of home equity allowed when applying to Medicaid is $840,000. Desipte the fact the home is not a countable asset, Medicaid, can look for repayment in probate court from the proceeds of a sale after it stops paying for care. It is important to understand if your home may be subject to the Medicaid repayment process.

Income Limits in New Mexico For Medicaid
In New Mexico the individual receiving Medicaid cannot have income over $2,205. If their income is over that amount, they will need to do some Medicaid Planning to create eligibility. One strategy that works well is a Miller Trust (also known as a Qualified Income Trust). If an individual is married, the spouse's income does not typically count towards the income cap, but it is important to maximize income protection via the Monthly Needs Allowance rules. The maximum amount of income the Medicaid office allows a community spouse to keep in New Mexico is $3,023 and the minimum amount is $2,002. All of an individual's income must go towards their cost of care, aside from $69 which is for a personal needs allowance.

[left-of-center2012]

42. Well, I have little in assets as I'm on Section 8 and little in the bank

I did have a neighbor at a prior apartment building who had to (I'm told) divorce her husband and live apart to qualify for whatever she got.
Having met both, neither appeared to have a pot to spit in.

Thanks for the input. I'll look into it and pass it along to my "medical and legal" power of attorney (my ex).

[pnwmom]

43. Even married couples can qualify, but as you can see, the spouse

can't keep a house if it's valued over whatever the current limit is.

So either they had a house over the limit or they weren't telling the full story.

[Backwoodsrider]

28. you can switch to Medicaid if you are in a nursing home for 90 straight days and your money runs out

And/or you meet your states eligibility qualifications (CA/APs) here in this state.

Those on Medicaid are not blessed they just meet the eligibility requirements.

[left-of-center2012]

39. I meant "blessed" in a good way

"... you meet your states eligibility qualifications (CA/APs) here in this state."

What state is that.

[womanofthehills]

37. In NM, there is an assisted living in Los Lunas that is really nice - greenhouses, restaurant, spa

Center for Ageless Living - located on 6 acres - fresh food from their own and local gardens

I've had lunch at their restaurant a few times - exceptional food, nice atmosphere. If you go into an assisted living/nursing home you pay until your savings drops to $2000, then Medicaid takes over. It's a good idea to pick a place you like while you still have a little savings and then you can usually stay there. This is what is so scary about the 8 billion cut to Medicaid. I went through this with my mom. First she was in senior living, then assisted, then high level assisted and finally a nursing home.

http://www.seniorlivingsystems.org/about/

Here is the bistro and bakery on the Campus of the Center.

http://www.greenhousebistro.com/

[blueinredohio]

24. It's pretty rare to find a non profit nursing home usually

they're ripping them off big time

[Victor_c3]

25. I've spent a lot of time living in a hospital setting over the last couple of years

I'm 37 and nowhere close to retirement home age, but my many extended stays locked up in psychiatric hospitals have taught me that a nursing home doesn't have to be a scary place.

I've never had any issues with staff mistreating anyone. Also, I've noticed that most people seem to be grouped with people at the same points in their lives - you have a lot in common with the other residents so friends are easy to make. There is usually always something to do and doing absolutely nothing is a nice break sometimes.

Nursing homes don't have to be a bad thing. If / when my time comes, I'll be ready for it.

[Backwoodsrider]

31. good to hear you point of view Victor

First hand experience and points of view of the various care facility situations are important

[UTUSN]

27. What the Repukes don't understand, or really, don't care about, is that Medicaid & such programs

not only help, but SAVE. What they're soon cutting - the in-home programs - SAVE by keeping people at home as long as possible with a few hours and meals at a fraction of the cost of long term care.

[pnwmom]

30. That's true. It's lunacy to cut Meals on Wheels, for example.

Programs like that help many seniors stay in their homes for much longer. It was only after Mom ended up in a wheelchair that she couldn't make it without a lot more help.

[George II]

33. Nice to see that, it's a hit or miss prospect whether someone will be happy or miserable....

....in a nursing home.

My mother was in two "assisted living" homes, basically nursing homes but she lived in her own apartment and had daily care. The first one she hated, it was almost like a prison, the other one was great, she loved it. One time, at 92 years old, she confided in me, "I have a boyfriend" (WHAT?????), "he wants me to sleep with him but I won't cheat on your (deceased) father"!!! Mom, I do NOT have to hear that, please!

Anyway, glad to see that she's happy.

[pnwmom]

34. Thanks, George II.

My mom also had a beau, for a while. Sadly, she outlived him. That's the tough part about having good friends at her age.

[womanofthehills]

38. My mom also found a beau in senior living & he helped her escape from a nursing home

My mom fell and hurt her ribs and she was keeping everyone awake in senior living so they suggested she go to a nursing home till the pain subsided. Nursing home calls me that my mom is missing - she had her boyfriend Manny (who had a big old Cadillac) sneak her out. Then senior living said she could no longer live there because she needed assisted living. She moved to an assisted living facility till she got kicked out of there because she kept calling 911. One time she took her own blood pressure and the cuff came up E for error. She thought E meant call emergency and she called paramedics. Finally she had to go to a nursing home.

[PoindexterOglethorpe]

35. Thank you for posting this, and thank you to everyone who has replied.

Nursing homes are not the total horror shows they used to be, although some probably still are. And those of us of the Boomer generation who've been through this with our parents are hopefully better prepared to plan for our own eventualities.

In 1999 I was researching assisted/independent living places in and near Overland Park, KS, for my mother. I'd found a place that would have been perfect for her, but she suddenly had a stroke and died. I often say we (her children) were spared a lot because of her sudden passing. But the place I'd found would have been terrific as it would have had her close to five of her seven grandchildren, she'd have done her grocery shopping at the grocery store I normally went to, and they had plenty of activities and events for their residents.

Over and over the story I hear is that someone resists going into such places, and when they finally go the LOVE it.

I know that finances are always an issue, and must be worked out individually. I'm only 68, in uncommonly good health, but still I think about such things frequently. I love where I live (Santa Fe, NM) but I know that if I live long enough I'll need some sort of health. My two sons don't live very close to me, and in the end I want to make various decisions as easy for them as possible.

There is no one answer, no one solution, and I'm glad you posted this to get the conversation going. I'd like to post a link to this in the Seniors forum, because I think that would be an appropriate place from which to direct people to this thread.

[pnwmom]

36. Thank you! I was surprised at all the attention this post got.

I thought I was writing for the relatively limited number in this Family care-giver forum, but obviously this is a concern to many of us.

A big thing my family learned is not to encourage a senior to use up all her funds in assisted living. The choices are much narrower if you have to enter a nursing home as a Medicaid patient. My mother was on the borderline between high-level assisted living and a nursing home. One sister was more comfortable with the idea of assisted living, and we could have kept her in one for a while. But then she'd have had to make another transition to a nursing home -- and whatever limited choices were available then. So, with her on the borderline, she was better off skipping assisted living and moving to the best nursing home we could find, as a private pay patient as long as her funds lasted -- and then switching to Medicaid when she needed to.

As you say, there is no one answer. Unfortunately, a lot of these decisions are made on the fly, after a parent has had an unexpected hospitalization and rehab and suddenly needs more care. So it's a good idea to learn as much BEFORE you think you need to.

[babylonsister]

45. My family is going through this, trying to make some decisions

now. Dad is living with my sister, he just turned 89. He has macular degeneration. He took a severe fall two days ago and we both have noticed he's very confused, imagination working overtime, wetting himself, etc. It's getting to the point where we don't know what to do to make and keep him comfortable but it's tough to find help around here to stay with him when we can't.
We're going to check out some assisted living places near here tomorrow.
Thanks for this thread and the ideas/experiences everyone shared.

[pnwmom]

46. I'd encourage you to also look at nursing homes, because he's probably

on the borderline between high level care of assisted living and a nursing home.

That's where we were when making the decision for my mom.

The best time for finding a good nursing home is when you don't desperately need one. Then you can take the time to find a good one, and get on a waiting list, if necessary. (Good homes often have waiting lists; so if you suddenly need nursing home care, you'll be stuck with whatever limited openings are available at that moment.)

Another advantage of finding a good nursing home is that you won't have to make another change in the future. If you put him in assisted living, he'll have to adjust to that change -- but in a year or two his condition might require a new move to a nursing home.

So we decided to find a good nursing home that Mom could enter as a private pay patient. This gave her a greater chance of being accepted than if we had waited till all her funds ran out and she had to be on Medicaid. (Even the non-profits need to have some private-pay people to help pay their bills, because the government Medicaid reimbursement isn't enough. Nursing homes will help their residents with the transition to Medicaid once their funds run out, but -- when accepting new residents -- most do give preference to people who enter as private pay.)

Good luck!

ON EDIT: Many assisted living places offer temporary "respite care" so that families can have a break and also see how their elder likes the place.

[babylonsister]

47. Thank you!

Dad does have some money but no one knows how long that will last; that depends on him. We just want him to be comfortable and not hate us too much for doing this. It's so emotional and difficult.

I will definitely look into non-profits. I volunteered for a n-p hospice center a few years back and did see the difference between them and the for-profits.

We will head in that direction. Thanks again!

[Arazi]

48. Thanks for bringing this