Bringing mom back home after more than a year in SNF. Any advice?

Caring, you mentioned "We just want to explore every option before having to sell the homestead, so to speak." 

Bingo. This is the REAL issue, deep down. 

Selling the 'homestead' isn't about the money, is it? It's more about what it symbolizes. It's a place where Mother was younger, where memories were made, and it's still seen as HER house. 

Selling Mom's house = Mom will never return home, nothing will ever be the same, any vestige of the 'good old days' is officially over and done. 

Selling the home is an emotional task, but it doesn't mean the love and good memories are sold too. You want to do what is best for Mother. Holding on to the house because selling will hurt everyone else's hearts is not helping her. 

She needs 24/7 SNF care from here on out, and you know it. As hard as it is, your family will need to take sentimentality out of the issue. It'll be okay. Do it for mom.

Caring, also before the family Come to Jesus meeting call the in-home care places to see just what their “minimums” are for your area. It could be 3 days a week 4 hr minimum at $20 hr. But it could be more for a bedfast stoke patient, like 3 x week 7 hr day $35 hr minimum and they fully expect you to have a Hoyer lift already installed beside her bed and also one as a bath sling. & maybe a specialized bed/mattress as well. Or are getting these ordered.

These are the kinds of things you don’t think abt but mucho importante!

Ordering & having DME aka durable medical equipment is on MiL to get and pay for. The inhome health Co can bridge this & add it to their bill; but may be cheaper for y’all to do this for MiL. DME & Medicare payments is confusing, seems MediCARE will pay for some durable to be “rented” if medically necessary. The Hoyers and pneumatic mattress/ beds combos can get a RX so “medically necessary”. If Mil goes onto hospice, hospice deal with DME routinely.

In-home Agencies in my experience expects their workers to drive the clients car if they will be taking them to medical or therapy appointments or doing clients grocery shopping. So as y’all will be doing this long term, your MiL auto insurance likely will need to have this added on as a rider. So speak with MiL insurance Co. BUT If MiL has already given up her car, all errand running around falls to you guys.

For an almost 4 month period we had in-home for my 90+ mom for post rotor cuff surgery. I took about a mo off, to get her house prepped for her return (moved ton of stuff 2 accessible height, cleared out permanently decades of high filled shelves, easy open foods) & after hospital release & to out patient rehab. She went to a sports medicine rehab place, it was awesome as AM was elderly patients and the PTs loved them like their grandparents. Mom was super motivated on doing at home exercises in between PT visits too as she wanted to be able to roll and set her hair & put on her “earbobs”. Vanity thy name is woman! I had to leave to get back for work so we hired InHome agency. Mom was totally cognitive but could not drive, or safely bathe or make a meal or do laundry so needed an aide. 3 days a week 4 hr min, like $20/22 hr. Some days when Dr visit would be 6 hr day. House nearby a bus stop. & caregivers tended to come by bus. Agency paid all insurance, FICA, workman's comp & vetts them. At post surgery month 4, we ended it, in writing. (& fwiw mom continued PT beyond what insurance paid and did it private pay for body strengthening & well worth it.) Had we not used an agency paying them & assuming responsibility would have been 100% on my mom. Realize paying is 100% on your MiL or your hubs family to do as those caregivers are as per IRS fully considered employees. Anyone paid - including family members - all need to get FICA done. Will not be simple. Should something happen while they are in MiL home, like a slip’n fall, this could mean litigation & $$$$ so Mil homeowners insurance needs a rider.

If someone in your husbands family suggests hiring under the table or says that FICA does not have to be done, that is another discussion.

MIL neighbors will have their own opinions on caregivers coming in n out of their neighborhood. Once friendly & helpful neighbors may not be quite so once there’s a stream of strangers coming & going and parking their cars or having their boyfriends or family waiting for them to finish their shift. If Mil house has been quiet, vacant since Spring of 2021, going to be huge change for the ‘hood. If y’all aren’t on regular communication w/ MiL neighbors, make that a priority. If getting work done make sure you have permits pulled too.

Hats off to you for doing Pro /Con on all this.
Personally MiL age is imho what keeps it from ever working. She’s gonna outlive her $ & probably even if she sold her home. If she was 90+, yeah risk it; but 79 not good odds. Let us know how all this shakes out, ok!

The OP further explains:

"I definitely agree that it is a LOT, againx100. I will say that it isn't about the inheritance. We just know that she took care of and paid the house off on her own. We just want to explore every option before having to sell the homestead, so to speak. While she means more, the home and the memories mean a great deal to my husband and BIL, and understandably so."

In reality, it IS about the 'inheritance' OP b/c you're trying not to sell the house & keep it intact for your husband & BIL. But at what cost to YOU, is the question?

If the mother has enough funds coming in to private pay for caregivers to come into the house daily to relieve you of this burden, then great. If not, then the house will have to be sold ANYWAY in order to tap into the funds to hire in home help. Or, a home equity loan or home equity line of credit can be taken out to pay for in home care or even long term care expenses. That's another way to avoid selling the house BUT you'd have to pay the loan back with high interest rates. Since this house will pass down to your DH & BIL, they can choose to take such a loan out. I wouldn't, but that's me.

One way or another, in old age, most people wind up having to tap into the house funds (their biggest asset) in order to finance their lives. Be it at home with caregivers (more expensive full time than in a SNF) or in a SNF. Sure, the house is 'important' b/c of the memories (and the $$$ value), but in reality, the health of the family members called upon to care for this woman is MORE important. If you keep that in mind as you move forward, and not agree to be the primary caregiver for this woman but one of MANY, then you may be able to make it work. You'll only find out when you try.

If this were me, I'd go speak with an Elder Care Attorney who's well versed with Medicaid. See what the requirements are in your state for your MIL to qualify. Being that she's only 79, she could live another 20 years and that would present a HUGE problem in terms of $$$$. See if it would be necessary for her to sell the home in order to qualify? Get all your ducks lined up so you KNOW what all your options are. That's what I did when I took over the management of my parent's lives in 2014. I was able to breathe once again after learning about VA benefits dad was entitled to, what the Medicaid requirements were, should he need it, and lots of other things that were extremely helpful to me. EC lawyers know about a TON of things we have no idea even exist. They can guide you with what's most beneficial to you in terms of finances. My motto has always been, be armed with ALL the information in order to make an informed decision.

@CaringinVA

Please don't do it. Listen to all the people on this thread. Difficult, obstinate, and stubborn with professional staff in a nursing home is absolutely impossible for family to handle.
You don't have to take her home and should not. That's just delaying the inevitable. Almost certainly will end up back in the nursing home. You're going to have to sell her house and spend down her assets then. Better sooner than later because you'll have to keep her for at least five years for the Medicaid look-back period. Your life will be ruined.
I was an in-home caregiver for 25 years. The last few years in the field I stopped taking invalid clients. The moving, transferring, diapering, dressing, will wreck your body even when you're properly trained on the correct way to do these things.
For your sake do not bring her home.

Caring, in going thru your old posts couple of things stuck out, your mom is on the younger side, like 79/80, so could mean another decade! or more of care & mom can be quite obstinate, like refusing to bathe (the “freshen up” dramas) & on taking meds. If she is this way around SNF staff who are pretty well versed in dealing with this, family is no match for her. Saying NO is one of the few powers a bedfast person has. She knows it and will use it. This won’t be pretty. The other was you are so gracious in thanking folks for answering. Kudos to you, you’re a sweetheart!

what everyone has posted on why you & your fam should not be doing this is spot on accurate. I’d like to add couple of suggestions: that you look at NH contract to see what the required in writing exit Notice is (could be 60 days on private pay) and get an assessment done ASAP as to what her needs are & do assessment BEFORE a decision is made as to have her leave the SNF to return to her home AND have the assessment in hand to discuss with family as to division of labor and changes needed in her home to provide for the safety / security of 79 yr old mom in her home.

SW at her SNF should be able to get a referral for outside assessment team for mom. Team tends to be a geriatric RN and a SW, they do a report and that with her care plan from moms last care plan meeting at the NH can be combined to be used to determine what needs to be in place at moms home before she moves back. Really you do not want workers there installing wheelchairs ramps the week she moves in, do this ahead of the move. Look in detail at the medication management schedule….. so if meds done X 4 a day, then someone needs to be in the home for that. If a Hoyer lift needs to be ordered, or a pneumatic bed & mattress brought in, toilet/ shower grab bars installed, etc all that done IN ADVANCE and mom pays for this from her own $ as it is her home. Her home needs to be made walker / wheelchair accessible so rugs removed, ramps installed front & back doors, doors removed, grab bar's as needed. Lavabos lowered for wheelchair height, yada yada. Y’all have an accessible roll in shower for her? You already know she already has issues with showers so just WTF is going to be done on her showering / bathing?

So moms home has been empty & vacant since Spring 2021, when she had a stroke? Is that correct? If moms home does not have phone line, WiFi, streaming, realistically, that needs to get put in. All the utilities need to get checked out ahead of time.
Now if someone has been living in her home, what is their situation once mom moves back? If someone was living there & not paying rent, expect that to be a point of contention within family meeting.

If moving her back is about not ever having her file for Medicaid, imho, I think that will be hard to do, because mom is so young. At 79, she could be with us another decade. A long time to be providing caregiving for free. Even if hiring in-home health, that a huge amount of $$$$. Unless she has M+$, she will run out of $. Then Hello Medicaid!

At some point in time, family will reach breaking point along w/no more $ so LTC or community based Medicaid will get filed for. Unless y’all can show exemptions or exclusions to Medicaids estate recovery or other legal (Lady Bird Deed, Trusts) & have the $ to support property costs on moms home till that is resolved (2 -4 yrs post death); Medicaid can attempt to place a lien or claim against the property.

I’ve been on this forum a long time, what seems to happen is family all cooperative for 6-10 months then it stops…. Nephew cuts 1/2 yard & leaves, Sissy forgets to pay prop taxes & Sil cannot do caregiving shift next mo… and all falls to you, the POA & good daughter. You know your family best & what is likely to happen. Good luck.

CaringinVA, you had mentioned hiring an Aide to help out. My Dad's caregivers were costing him $30/hour, they were from an Agency, licensed, bonded, insured, plus the Agency had workman's comp in case an caregiver got hurt on the job [can happen when lifting a person]. The Agency handles the payroll. If the Agency caregiver is unable to make her shift, the Agency will send another caregiver to fill in.

My Dad eventually had 3 shifts of caregivers per day as he was a major fall risk. That was costing him $20,000 per month, yes per month. Dad decided to move to senior living where it would cost him between $5k-$7k [this was 5 years ago]. Dad sold his house and used the equity to pay for senior living.

If you hire a caregiver who is not from an Agency, you would need to contact your homeowner's insurance carrier about getting a workman's comp policy since you will be now an employer, and about possibly having extra liability insurance.....

Also, you would need to do a background check on the caregiver. If covid and flu are important, make sure that person has had all their shots. And figure out how to do a pay check minus payroll deductions.... there are companies that will do that for you, for a fee. And if said person is unable to come, do you have another person able to come in to help you?

So much to think about. Let us know what is decided.

Do. Not. Bring. Her. Home. You are not seeing how rough this will be.

There is a reason people are telling you to not do this. Hundreds of people on this board thought they could do it themselves too. Now they are exhausted, broken mentally (and physically) and wish someone had warned them. Consider the following:

-Whatever schedule you have now will be out the window.

-There will be no more dinners out, no vacations. Friends and family will say to call if you need help, but  almost none will volunteer to stay with her if you need time out. 

-When do you plan to get things like errands and grocery shopping done? She cannot be left alone. 

-Can you lift her multiple times a day and night?

-If she worsens, how will you handle the medical needs?

-Are your toilets, bathtubs, etc handicap-ready? Will her bed have safety rails? Are meds stored safely?

-Can you handle multiple toilet visits, butt wiping, diarrhea, bed urine, and getting her undressed/dressed? Multiple times a day/night?

-Are you able to help with bathing daily?

- If she keeps you up at night, how do you plan to handle work/chores the next day? Same goes for working from home. 

- If you get sick or injured, what plan do you have for her care?

- You'll very likely need aides. Are you okay with strangers in the house?

- If you are no longer able to care for her, how will you get her back into a nursing home? 

I've said before that people think they can "love their way" through caregiving. That love will be enough to sustain their energy and will. It isn't. Nor is it the same as caring for a baby. Caregivers here loved their elder dearly. They had to place their elder to save both of their lives.

This is way too much to do at home. A bedridden person is VERY difficult to take care of. YOU will be burnt out in a VERY short period of time. For me, it'd only take a couple of days and I'd be running for the hills!

Forgot about trying to save money! She's going to need a lot of care. Who's idea was it to bring her back home? Someone hoping to get a nice inheritance? Yes, it sucks to see your inheritance going down the drain but it's NOT our money. Put her needs first and leave her right where she is, money be damned.

Please share the responses you've been given with your husband and brother-in-law. They need to see beyond financial considerations and realize the immensity of responsibility that will be on your shoulders. And honestly, reading in your profile about your mil's health concerns, your home is probably not a totally safe place for her to be at this time in her life. Your husband and bil need to do what is best for her, and I think bringing her home is not best, not better, not even good for her.

You won't find encouragement here for this idea. You are bringing home a person who needs the highest level of care while not being able to provide that level of care. This is akin to bringing someone who needs surgery home from the hospital and taking a chance on doing the operation on the kitchen table instead. ("It'll be FINE -- trust me. The knife's not THAT rusty!")

Please don't do this. It's akin to abuse in my book, because there is no way you'll be able to give her the kind of care she's been receiving, even with paid help. Home caregivers are not trained at the level of the caregivers where she's been. They are not trained (or allowed) to give medication, they are not RNs, and they won't recognize medical issues that will inevitably come up. Heck, the caregiver I hired for my mom didn't know how to load a dishwasher and she showed up to work sick on her second day. If you watch what's going on with her care now, you'll see that she isn't cared for by a single person at a time. There's a team working to care for her during every shift, backing up one another when they have heavy tasks to do.

What will ultimately happen is she'll have a medical crisis and end up exactly where she came from -- in a SNF. Are you going to bring her home again if they can stabilize her enough? Then the next crisis comes, off she goes to the hospital, back to SNF, and back home again? How many times will this go on before it finally kills her?

Seriously, this is a very, very bad idea.

Have you even considered Medicaid. The house is an exempt asset while Mom is alive. When she passes, then its an asset that Medicaid can recover from. A lien will be put on the house by Medicaid. Then you sell the house, the lien is satisfied, and the balance of the proceeds go to the beneficiaries. As the woman you will be doing the grunt work.

"Praying for wisdom as we make our decisions." Count us as giving you that wisdom. Not one person has said "yeah go ahead and do it".

This reminds me of a story about a man and a flood. He ended up on a top of a roof. A boat came by and he refused it saying God would save him. Then motor boat then a helecopter and he repeated the same thing "God will save me". Finally the guy drowned, went to heaven and asked God "why did you not save me" and God said " “I sent you a rowboat and a motorboat and a helicopter, what more did you expect?”

You have more than 3 people telling u this will not work.

 "It was hard work then, so I am anticipating more work for us now that she is not." And who was it hard work for, I bet you. I have a feeling your not completely on board for this. If you are not going to get any help and I mean like at least an 8 hr shift, I would not even contemplate it just to save a house. My Mom did not have much but every sent she had went to her care. Her house did not sell until after her passing, the tax liens and Medicaid liens were satisfied as were my out of pocket. We kids got 10k to split between us. We could have cared less if we had gotten anything.
God was with me all the way because everything just fell into place.

I would use her funds for her care. Her house need not be sold to qualify for medicaid, but of course there will be clawback for what the government paid for her care when the home is sold after her death.
The monies your Mom has now are hers. She should have good placement for her care and be able to use those funds. I wish you luck in finding her the best care you can for the assets she has worked her life for.

“….her funds….”, you said, right?

What are you planning to do with the funds you will attempt to be stretching?

When she lived with you, did you do the majority of the caregiving? How much did bil and H actually help out?

What's wrong with her selling her home to pay for her care?

If she is bedridden, and has no funds, doesn't Medicaid pay? Bringing her home will be so very hard on you. Not just emotionally. Lifting someone who is dead weight is very, very hard on your body. You may end up injuring yourself. Then what happens to your mom? It's safest to keep her where she is.

CaringinVA, also think about the fact that maybe your Mom-in-law may have made some friends at the skilled nursing facility. Do you really want to pull her away from those people because no one wants to sell Mom's house and use the equity?

Also note, that up to 40% of family caregivers die leaving behind the person they were caring. Chances are you would be the one doing the vast majority of the work. Does are not good odds. Then what? Chances are your Mom-in-law would be back in Skilled Nursing but without her daughter-in-law to visit her and your husband without a wife.

Thank you everyone who took a moment to reply. This is not an easy option for any of us involved, and we are quite aware of the many factors we must consider. Praying for wisdom as we make our decisions.

In addition to all the other comments, let’s not forget that when a woman is involved in caregiving, she’s going to be doing most of it. Forget hubby and brother. Would they be around to handle poop blowouts? Is it even proper for two men to be cleaning their mom’s intimate areas? As a daughter in law, do you want to do that? Who disposes of dirty adult diapers at your house? Who orders them? Do you know how many you’ll need per week? Ever heard of a Hoyer lift? Where will you put it? Will you all learn to operate it? How many PT people will be in and out of your house per week? When will you go to the store? Better learn how to order almost everything online and have it delivered, because she can’t be left alone. What meds does she take? Who will manage them? Will her docs come to the house? If not, how will you transport a bedbound patient? Does someone need to sleep next to her at night? How will that person get enough rest to go about daily tasks the next day? Are there children in the home? What resources do you have to help them cope with a sick bedbound person in the home? The smells, the noises, the disruptions of schedule? Do you have hobbies or a job? If so, let me tell you what the social worker said to me. “You can forget about that. You’re a caregiver now.”

Leave her right where she is, sell her house, and allow mom to use her own money to finance her care in the correct environment. What do you know about how to care for a bedridden elder? What qualifies you to do so? What will you do when she develops bedsores from not being turned every 2 hours?

I suggest you go down to the SNF and ask if you can care for mom all by yourself for a few days. Changing her briefs in bed, dressing her, feeding her, meds, turning her, bed baths, all of it. But you will also be COOKING the food you're serving her and then cleaning up the kitchen afterward, once at home. You'll do her laundry and change her bed linens each time they're soaked or soiled, too. See what it feels like to do that for a few days in a facility that is fully equipped with all the supplies and food you will need. Then imagine doing it for her at home 24/7/365 with only the supplies and food you go out to buy and drag back home.

You're in over your head, to put it mildly. Remember why you placed her in the SNF the first time, then multiply those reasons by 10, and you'll have the reason why mom needs to stay put now. Take money out of the equation too. Why do her funds have to "stretch"? If they run out after you sell her home, apply for Medicaid. Unless you are living in her home and that's why you are wanting to "keep from selling her home".....which is a horse of another color.

Sell her home.

It’s her asset. HER money. For HER care.

You’ll regret bringing her home. She needs THREE shifts of people to take care of her. The countless people here who have attempted the same, will attest to that.

REALLY??? What in the world are you thinking??? And all this because you don't want to sell her home for her care? Again, REALLY? It's her house and the funds from it should be used for her care.
You have no clue what you're getting yourself into. She's now completely bedridden and will need to have her diapers changed every 2 hours, turned in the bed and bathed in the bed as well.
Are you prepared to physically do all that? It's a 24/7 job and it's exhausting. I know. I cared for my completely bedridden husband for the last 22 months of his life in our home. And that was with an aide coming in the mornings to put him on the bedside commode so he could poop, and hospice aides coming twice a week to bathe him.
And still I was exhausted and never slept well, always having to have an ear open to hear my husband if he needed me. It definitely took its toll on me physically, mentally and emotionally and even spiritually.
I'm afraid you're in for a rude awakening and will live to regret your decision to bring her into your home, so my only advice to you would be to leave her where she's at where she's receiving the 24/7 care she requires, and sell her home.

This is an enormous undertaking. How much help do you have? Please don’t take it on alone. I’d assume she’s a two person assist to move? Can she help in turning herself or cleaning from changes? At the least, hire a CNA for a while to show you the in home tricks of the trade. Sacrificing your own health to do this, or possibly having your mother in an unsafe position are both scary prospects. If this was my mother, I’d sell the house to pay for professional care. I wish you the best

Why do you feel the need to keep moms house rather than sell it? Since moms care has increased significantly I also think you are making a mistake trying to bring her home.

There’s no encouragement from me. What you are planning to do is exhausting, miserable, possibly unsafe for her, and could tear your family apart. No one is prepared for this, ever.

Please sell her house and leave her in SNF. That’s where someone who has her issues should be.

Read posts on here from people who have done this. It’s not pretty.