John Danner, LCSW Answers Your Questions
John Danner is a licensed clinical social worker with the USC Memory and Aging Center and welcomes your questions.
To contact John Danner, LCSW with a question, please email firstname.lastname@example.org.
My mother has been diagnosed with Dementia for about a year. She has no savings, has Medi-Cal, and receives In Home Support Services (IHSS). She now has 45 hours a month of help. I now realize that she can no longer be left at home. Last week she got distracted while cooking, left the kitchen and “took a walk” because she “thought” she recognized someone who walked by the house. A neighbor called the fire department when the smoke alarms went off. Mom didn’t lock the door, so the fire department guys walked right in and put out the “smoking pan”. I have since turned off the gas to the stove so she could no longer use the stove. Mom is very angry with me about this!
I do not want to place her in a nursing home, but do not have the money to hire a full time helper. I can’t leave her alone anymore, even though she insists on it. “Don’t worry about me, I’ll be okay”. I can’t quit my job, as I help support her to stay in her own home, and have my own mortgage and car payments. She refuses to move in with me. Help!!
Dear Devoted Son,
The first thing to consider is your mother’s safety. She is at risk of hurting herself, burning down the house, getting lost, being at the mercy of strangers, unable to respond to an emergency, etc.. She needs to be protected from her lack of judgment. She has forgotten the basic rules of self-protection.
I would first find someone to stay with your mother while you set up a system of 24/7 safety for her. There are special services available to persons with IHSS and Medi-Cal that can help, but it takes a little time and perseverance to make the services and programs work together for you. I would immediately call the IHSS social worker and report the fire, her wandering off, your safety concerns, and any other dangerous things she does. You may quickly get more hours this way. I would then have her tested by a dementia care neurologist to get a testing baseline of her memory loss and cognitive changes. Ask the IHSS social worker to send the SOC-821 form to the doctor. This form is for the doctor to report her level of memory, orientation (gets lost), and judgment (makes mistakes). If she gets full Protective Supervision she could get 283 hours a month to cover a day time chore-worker/companion. This maximum coverage is for 9 hours a day, not 24 hours. You will need to find someone who can live in.
I would next find a local Adult Day Health Care Center (ADHC). There are around 200 ADHCs in Los Angeles County. They are paid 100% by Medi-Cal and with the right doctors information on the Treatment Authorization Request (TAR) that the ADHC sends in, your mother could get 5 days a week at the ADHC, from approximately 9:00 A.M. until 3:00 P.M..
If your mother owns her house outright (no mortgage payment) she (you with a power of attorney) could get a Reverse Mortgage to pay for the extra care she needs for 24/7 coverage. This “reverse mortgage income” is not counted against her as an asset for Medi-Cal purposes. This seems super complicated, but with determination it can help put together a care system that can keep her safe.
I would also call the Alzheimer’s Association (323-938-3379) and the Los Angeles Caregiver Resource Center at (213-821-7777). Both these organizations help with support groups, respite care, and are designed to help the “care giver”, that’s you!
I hope this has helped.
My dad is followed by Dr. Chui. He is deteriorating in his thinking, but is still ambulatory, and my mother is afraid he will start to wander. We want to start looking now into possible placement facilities soon, as it is getting more and more difficult for my mom to care for him on her own. She worries constantly. Any suggestions on places for someone who is low income and a Medi-Cal recipient?
Marie (name changed to protect the privacy of the family)
The question is a good one, but have you considered having In Home Support Services? It is a Medi-Cal program which can pay for someone to help mother care for and manage your father. We can talk about this and I can guide you with the application and paperwork. If you want to have a placement plan "in your back pocket" , that is a good idea.
I cannot routinely suggest any particular place because, if the staff and especially the head of nursing changes, the whole place changes. Last year’s "good" facility may not still be. You will need to visit each place first by location and ease of visiting (your town, zip code), then by atmosphere, including the "sniff" test. If you smell urine or disinfectant it is usually a bad sign.
The next consideration is finances. Those with Medi-Cal usually can only go to a Skilled Nursing Facility (SNF) and those with moderate means might choose an Assisted Living Facility (the monthly out-of-pocket cost starts at $2,500 and goes to $6,000). The SNF can be financed by Long Term Medi-Cal (100%) and because there is a "spousal protection" to not impoverish the community dwelling spouse. If you need an e-file for the "Spousal Protection" program from Medi-Cal just let me know. This is a special program exactly for your parents situation. The community dwelling partner (mother) is allowed to keep income, home, and car, while Medi-Cal pays fully for the SNF.
To find a list of facilities near you, I can suggest the following:
1) Go to the website: www.newlifestyles.com
2) On the left hand of the web page it says:
"Find senior living and care options as well as senior products and
services in your area"
3) Input your City, State, and Zip Code.
Follow the prompts and find all the local facilities. Then check them out by phone, asking if they have openings and if they take someone with your father’s characteristics. Do not tell them that he wanders unless he actually does.
Since we have some time, I would be happy to assist you on the phone to strategize this contemplated decision and review your progress.
Sincerely, John Danner, LCSW
My aunt (85) and I were at the Social Security office for a review of her eligibility for SSI. The person who took care of the paper work was very friendly. With regard to the old 'joint account' bank account (which I recently closed), he said there was no need to include the information in the form, so we plainly left it out. We only included the information about her own bank account that we currently use. Was that the correct thing to do? We also did the form for “representative payee”, so things may be resolving after all.
I have a question regarding the info that is currently at the SS office. The form indicates that my aunt "is not blind or disabled", which is not accurate. Is that important at this point? I did not read all the pages when we were at the office, otherwise I would have changed it at the Social Security office. Please advise me on this, the form says to contact them in 10 days if changes are needed.
Thanks for the follow-up.
Jean (Name changed to protect the privacy of the patient)
Nice to talk with you today. So glad you are taking care of things for your aunt. I will send you an Advance Directive document so you can become her agent as Power of Attorney for Health Care. Please read the instructions, fill out the form, have 2 witnesses for your aunt's signature, make copies for her doctors. This means that you can speak for your aunt if she is unable to make her own health care decisions. As to the Social Security office and their assessment of “blindness and disability”, I would let them make the decision as to category of SSI payment. Cortical blindness is a neurological disability. Her diagnosis should not change her award. Make sure to have them send the form to her neurologist here at the USC Memory and Aging Center. Should you need an additional medical letter to describe your aunt's Alzheimer's and cortical blindness, her neurologist can provide that as well. The paper work for the “representative payee” will clearly indicate that she is disabled.
Do call or e-mail any questions.
John Danner, LCSW