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My 83 year old mom is currently in a SNF after a 3-month stint in rehab after a stroke. She is utterly miserable and desperately wants to go home. Her apartment is completely wheelchair accessible. The only issue is that she currently needs two people to transfer her from bed to wheelchair. She needs 24/7 care and obviously I can't hire two aides to be there at the same time to do the transfers. I know that there are Hoyer lifts that can be operated by one person. That seems to be the only way she can go home. Does anyone have any experience with a home aide who can operate one of these alone?

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I remember back when my Mom was in long-term-care and two Aides were using a Hoyer Lift... poor Mom was screaming "let me down, let me down", she was so terrified of that lift. So, Xina, it would depend how your Mom would react to being lifted up in the air in one of those things. Some people don't mind it.

As for having an Aide to this work, it would be best to hire someone who has a lot of experience in using a Hoyer. You don't want someone experimenting for the first time on your Mom.
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When I worked in LTC state law stated that Hoyer and Sit To Stand Lifts required two people. I don't know about home care requirements..
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Flyer, My mom has been in the lift many times in the rehab unit. I am determined to get her out of the SNF and this is the only obstacle. I am determined to find an aide who can do it alone! No way can she stay where she is. She is panicking and completely miserable and depressed.
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If you watch the CNA training videos on Utube you will see that almost every transfer begins with "summon the second aide". That is mandated protocol in hospitals and care facilities but a luxury that most of us don't have at home, and many people use lifts in their own homes. I expect that most agency caregivers will not be allowed to use a lift solo but, if you hire privately you can probably find someone. There may be extra insurance and liability considerations if you go that route.
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New York State department of labor rules call for two people, one to run the lift and one to steady the patient. Since they implemented that, injuries dropped by 56%. If you get yourself trained, you can be the second person.
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I've got to find a way to make this work as my mom is extremely distressed at being in the SNH. I wish they made a wheelchair that turned into a bed, like a lazy boy! Honestly, I think she would prefer being bedbound at home to living in the SNH, crazy as that sounds! But I refuse to believe she can't go home because of the transfer. She doesn't use the toilet anymore and can be kept clean without a shower. So it would be two transfers per day--morning and evening. She does have some core strength and can use one leg and one arm, so she's not a total dead weight. I'll find a way!
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Xina, my knowledge of th is is limited to this. I was told 3 years ago by a knowledgeable person that in NYS, a lift is a two person assignment and the use of them is likited to nursing homes. The law at that time was different in Connecticut, where a lift can be used by one person in an assisted living facility. You might want to check out NJ and PA law as well.

Have you been in touch with the sw at mom's apartment complex?
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Limited
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Xinabess I did it myself. The first time it happened because I was by myself and it was the lesser of two evils; and subsequently, of the dozen or so aides who came to the house I considered only two to be better at the job than I was; they were more experienced and defter, but I was more punctilious. One I actually halted in mid-operation because she was so mechanically inept it was dangerous.

You will not get a professional home care aide to do it solo, and it would be unfair even to ask; but as Pam points out you can be No. 2 on the team with approved training (which shouldn't take more than a couple of sessions). I was given demonstrations by the PTs at rehab before my mother came home: you could do worse than ask at your mother's ltc facility, they can only say no.

Other important differences between facility and home operation:

Flooring. These lifts are designed to be moved around on smooth surfaces like lino or vinyl. We had carpet, though fortunately with a very short pile; but it didn't make life any easier.

Space. Facilities are laid out to purpose-built designs. You will probably need to rearrange your mother's environment considerably to allow adequate room for manoeuvre.

Help. What if it goes wrong? Who can you call if there is a problem, and how long would it take for anyone to get to you?

Spares. You will need several slings *of the right size* because they need to be thoroughly laundered, dried and aired and you can't put them in the dryer.

Co-operation of the patient. Facility staff are good at getting the job done without - how can I put this - necessarily paying too much attention to consent every single time. "It's time to go to the bathroom Mrs X" and in they charge and get it done and the patient doesn't really have time to think about arguing, let alone get in a tizzy. That's not to say that if the patient did say "unhand me, how dare you" they would persist in transferring her - but it sort of doesn't come up for discussion. Are you going to be able to take the whole thing in your stride in that way? Would your mother have the same confidence in you, and feel safe?
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I'm wondering if she can hold herself upright once seated, and just how much strength she has in that arm and leg... would it be possible to forget the lift and use manual transfer aids? I'm thinking of an overhead trapeze, transfer boards and belts, slide sheets and pivot discs. It is all a lot of physical work but may be an alternative worth considering.
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Well, I will just make it clear that if she gives the home health aide a problem, she'll go right back to a SNF. It's just so horrible to be in this position, as so many of you know. My mom still refuses to accept that she even needs this level of care. It happened overnight, with the stroke.

Believe me, it would be a hundred times easier for me if she was in a SNF. That was my plan until she was transferred to longterm. It's so depressing and I can't bear how miserable she is. So she's going home one way or the other. I've become horribly cynical and of course I love her to pieces, but being "safe" in an SNF might be worse than being at risk of a problematic transfer at home. No one lives forever, after all, and 90 percent of the folks in the longterm care unit seem to have no life at all.
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Ugh. This is so stressful. As of today, I'm thinking the ideal compromise would be for my mom to have a private room in the longterm care unit where she is now. She has a roommate who watches TV at a high volume ALL day. I can't even believe they allow that. She keeps asking for a private room, but from what I've been told, those are reserved for private-pay patients, not Medicaid-pending ones. I feel stuck between a rock and a hard place. Home care is not ideal and complicated for numerous reasons, and SNF care is undesirable too. I just want to run away!!
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Xinabess, have you had discussions with your mother's medical team about her long term prognosis?
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According to the Nursing Coordinator during the last care plan meeting, she is medically stable for now. Her main issue is her lack of mobility due to paralysis of her left arm and semi-paralysis of her left leg.
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You talk to the sw about them getting the roomate a headset. That's what we did.
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Well, I have made a decision: My mom is going home with 24/7 care. My elder lawyer recommended a great home care agency that gets fabulous reviews. I spoke with the care coordinator today and she is lovely. She sent me a questionnaire and we spoke. She is coming with me to the SNF to talk to my mom about all this on Friday. From there, we will go to her apartment for an assessment of equipment needs.

My mother is MISERABLE at the SNF, talks about going home all the time. But she has lived alone for 30 years and lives in a large one-bedroom apartment (i.e. not a lot of space). To have someone there 24/7 is a HUGE change. She is upset and not even able to accept that she needs so much care. So there are challenges ahead. Sigh.
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I hope she feels more at ease in her own home, but I'm afraid she is probably miserable about her loss of independence and the betrayal of her body and there is no fix for that.
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cwillie, no, once mom lost her left side, the only option was a hoyer lift, from bed to wheelchair or toilet, (suspended over toilet) and back again. A ceiling lift will get them from bed to wheelchair, but then you would need a second ceiling lift over the toilet and possibly a third for the shower.
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Xina, does your Mom understand that having caregivers 24/7 from an Agency is going to be expensive?

Here in my area when I had 24/7 care for my Dad, in his own home, the cost was over $20k per month [yes, per month] just for the caregivers. He still had the cost of maintaining his home, utility cost, property taxes, homeowners insurance, groceries, lawn mowing costs, etc.

It wasn't long until Dad moved to Independent Living, and is now in Assisted Living/Memory Care and he cut his cost in half. Whew. Now his savings will last much longer.
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Freqflyer, home care in NYC is actually almost half the cost of the SNF. I can't imagine why, but it is. With the help of an elder lawyer, we are putting a large chunk of my mom's assets into an irrevocable trust. The rest will have to be "spent down" until she qualifies for Medicaid, which pays for SNF or 24/7 home care. My mom lives in a building that is subsidized for performing artists. She has a wonderful apartment on the 29th floor overlooking the Hudson River for next to nothing. So she has no property taxes, lawn mowing expenses, utilities, homeowner's insurance, etc to worry about. She is extremely lucky in this respect.

Does Medicaid not pay for home care in other states? I am wondering why so many people in NYC end up in nursing homes when home care is covered by Medicaid.
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Medicaid does not cover 24 hour home care in Minnesota, simply because here it is far, far more expensive than a care center. They will pay for a certain number of hours per week, but it will never be 24 x 7.
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I rarely hear that Medicaid will cover in home care around the clock. Like Jeanne mentioned above, it is far cheaper for the State to place a person into a skilled nursing facility. If this is available in New York State, you are lucky that the taxpayers are willing to handle this cost. Thank goodness Medicaid is available in any event.
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I am in NY. The cutoff is 8 hours per day. One aide only. Honest. As an Ombudsman, I am working with a case right now where a woman wants to go home. She also needs a hoyer lift. Unless her housemate gets the training and is willing to change her diaper every 2 hours, she's at a real roadblock.
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Pam, the OP is talking about New York City which does have access to 24 hour care by law. Here is website talking about the new regulations that were set up after Dec 2015 when a lawsuit was settled.
"NYS has two types of 24-hour care available when medically necessary. The definitions of these levels were just amended by regulation effective December 23, 2015. The amendments were adopted in part to comply with a settlement in Strouchler v. Shah, a lawsuit that was settled in federal court in Oct. 2014, after the court issued a Preliminary Injunction against NYC HRA in Reducing 24-hour Split-Shift Medicaid Personal Care Services (Sept. 4, 2012 ). The regulation published Dec. 22, 2015 is the final version after the State Dept. of Health issued a series of emergency and proposed regulations since 2011. Here are the new definitions effective Dec. 23, 2015 - also see GIS 15 MA/024 - Changes to the Regulations for the Personal Care Services Program (PCS) and the Consumer Directed Personal Assistance Program (CDPAP) (PDF)​
https://www.health.ny.gov/health_care/medicaid/publications/gis/15ma024.htm
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I would actually prefer that the care was divided into shorter shifts. I don't know why they do it this way. They will have one caregiver there 24/7 Mon-Thurs and another one Fri-Sun. My mom doesn't get up in the night, but since she can't walk or do anything for herself, we can't just leave her in bed alone and hope nothing happens.
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Update on the transferring issue: Both of my mom's aides (who split the week, so they are never there together) can transfer her by themselves without the lift! We have the lift, but so far no one's needed it. So clearly the 2-person/lift rule is something specific to SNFs and doesn't apply to home care. Phew.
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Please help. Don't know if this is still an active thread. Xinabess, how much does your mom weigh? My dad weighs 230 pounds and is a tall man. He is currently in the hospital with pneumonia. We just moved him from California where my brother was emotionally and psychologically abusing him and took between $250,000 and $350,000 from my dad over a 5 year period. Dad has an income of $7,800 per month. Up until recently, his care costs were around $3,000 to possibly $4,000 per month at most. My brother was spending all of it, plus some of his savings. I tried several times to intervene, talked to dad's elder care lawyer (who was useless and also making money off dad) but no one would listen. When dad began requiring two person transfer, my brother put him in a horrible board and care home in California. As soon as I saw the situation, my husband, who is a contractor, started making renovations to our home so we could bring dad here. I'm hopeful he will be strong enough after rehab to use a sit to stand lift. We may need a hoyer. Not sure. It is a mess. Any advice from others on lifts? Before the pneumonia, he was able to bear some weight on legs for 30-45 seconds or so.
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What makes me sick is that if my brother hadn't taken all this money, and had put it in savings, dad would have had plenty for his care now.
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Re Hoyer lift -- my husband is 250 and 6'5". I recently asked his neurologist for the lift as it is becoming more and more difficult for him to stand for any amount of time at all and transferring is getting harder. We have been using it to get up in the morning and for transferring to bed. I was trained by the PT who came to the house to evaluate the situation and then to train me about 3 times. It is not an easy job but doable by myself. I have also used it to get him off of the floor after a "fall". The caregivers are using it but am not necessarily happier with one of them following my directions. After a bad couple of days am looking at the next step -- whatever that will be. Probably using for toilet and showering -- not sure how that will work. My husband cannot stand for more than a second or two then screams that he has to sit and just sits -- wherever -- with me holding the gait belt. Not a good situation. Good luck --
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We had both a Sit to Stand and now have a portable lift. My husband weighs over 300. I’m not a weakling, but I can tell you that most lifts have a mind of their own. You can be pushing with all your strength in one direction and either it won’t move or it rolls in the opposite direction. Ours is a hydraulic, and if I am having a bad shoulder or back day, forget it. Hubby is better now, but he could be known to yell and hyperventilate.

If your Mom is of normal weight and size, I would think it would be much easier. If you’re at home alone with her, nursing home rules don’t apply.
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