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My dad lives alone - he is 95. He can barely walk (but still drives!) due to diabetes. His mental functioning is not impaired. He has very little money and no assets. He has life estate in the house. He refuses to go on Medicaid later on because he won't give up control of his money. There is no money for an aide or any outside assistance. No one will take him in for various reasons. And from what I have read on this forum, this is not a good idea anyway. He has created many Medicaid penalties during the nursing home lookback that can not be cleared due to lack of money. What are his options? Do we call APS when he stops walking completely? And what would they do? Is there placement in some kind of indigent nursing home? I should mention he lives in a state where there is no filial support law.

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I just want to say when I brought up the subject of "unsafe" discharge to my daughter she said that Hospitals to not fall under this. They can send a person home without taking in consideration if they person can care for themselves or not. So my recommendation is to check your State laws when it comes to ER dumps and "unsafe" hospital discharges.

Daughter has worked in rehabs/nursing homes for 20 yrs. They are different. They cannot release a person if its unsafe. They can't force u to care for someone either. They will try but they can't force. Average NH care can cost 10k or more a month. A persons SS and pension go towards their care in a NH. Medicaid does not pay the full balance. With my Mom, she was on Medicaid for LTC 2 1/2 months and she owed 6k. She paid 1700 a month, it cost 9300. Medicaid paid an average of 2400 a month leaving 5200. So NHs make no money off a Medicaid resident. So of course they try and talk the family into caring for a LO.
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If your father has neuropathy from the knees down, as you say, then he should NOT be driving a car under ANY circumstances, PERIOD. Remove the car and the keys otherwise, he will likely kill himself and/or others while driving with no feeling in his feet. I was fortunate in that my father had the presence of mind to voluntarily stop driving when his neuropathy reached that point, thank God.

I would not bother with his doctor & the DMV...........just remove his car; that's the only way to ensure he will not drive anymore.

If your father falls at home and goes to the hospital, they won't 'send him home in a taxi' if he's in bad shape! At 95, I seriously doubt many elders would be sent home to live alone by the hospitalist b/c that constitutes an unsafe discharge. At the least, he'd be sent to rehab and then from there it would be decided IF he could go back home to live alone.

Good luck............you may have no choice in anything until & unless he hurts himself and does go to the hospital. Then you'll deal with the aftermath. Not a good feeling or position to be in with a stubborn elder, I know.
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Not much you can do but wait. But, I would take his keys and car away. I may even say something to his Dr. who should be able to contact DMV but with COVID it will probably take months to carry that thru. You Dad, because of his diabetes, probably suffers from neuropathy. Meaning his ankles and feet will go numb and he will not be able to feel the gas or break peddles. He will either kill himself or someone else.

The best way to get him help is hope he goes to the hospital. Then hope he goes to rehab where you can have him accessed for 24/7 care. If found he needs it, be very firm that he can't afford care at home and you cannot care for him. Rehabs cannot release if not to a safe place. Its called an unsafe discharge. Medicaid can be applied for. Whatever monies he has will be spent down and his SS and any pension will go towards his care with Medicaid paying their share. At this point, you can have the State take over, especially if Dad didn't assign you POA. You cannot be made to care for him. Its easier for the SW to have u take on the care, otherwise, she has a lot of paperwork to deal with.

My daughter says hospitals are not under the same rules as rehabs. They can release someone. If you refuse to pick the person up, they can send him home in a taxi.

Just thinking here. I know usually with having life estate in the house it stops once he passes. I wonder what happens with the house if he goes into LTC? This house probably should not be considered in the Medicaid application because its really not his house. Medicaid would not be able to recoup eventually from it.
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jolobo Jan 2021
Thank you. I have heard that Nursing Homes will also do that with the taxi. And I remember when my mom was in rehab they pretty much forced us to say that we would care for her so they could release her. They told us that is what children do. I was so surprised. I remember looking at these young people telling us this and thinking - you really have no idea, do you. Anyway, he doesn't have a PC doc because no doctor in the county he lives in takes new patients with Medicare (his doc retired last year). It's a terrible situation there. They make you pay up front at best and then put the form in to Medicare for you to be reimbursed and of course you don't get reimbursed as much as you would have saved if they took Medicare. Really terrible. Yes, he does have neuropathy from the knees down - he can't feel a thing. Maybe I will call the DMV myself. I think with life estate, if the person is expected to return then nothing happens, it's still his house.
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Because of his resistance to sharing control of his affairs, it will (ironically) be taken from him eventually, if he doesn't die in his home first. You say he is fully functional mentally, so I would explain this to him. I would call social services to come do an assessment to see if he qualifies for any in-home services. I would make sure to be there for this appointment. At that time you can ask the pointed questions (about state/county guardianship) and let him hear the answers from someone other than you. That's as much as you can do. I was in the same situation with a step FIL with Parkinsons.

Regarding his driving... if he can barely walk this means his physical reaction times are not at a level that makes him a safe driver. Not to mention the possibility of having a diabetic medical issue while behind the wheel. Please remove his car (not just his keys) from the premises so that he can't become a weapon on the road. Make up a "therapeutic fib" if necessary: "the car has a very expensive problem, they're waiting for parts" etc. My uncle was in his 90's and went through a red light, got t-boned which killed his wife and dog and injured the people in the other car (and fortunately not seriously). Please do what you can to prevent this from happening. I wish you much success in finding him help, and may you gain peace in your heart that you're doing all you can in a challenging situation.
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jolobo Jan 2021
Thank you. His truck is registered to my sister's floral business so she would have to take it. She would never do that because she is in as much denial as he is. Even if I contacted DMV, and had his license revoked he would still drive, I believe. He is very very hard to talk to, so I will write to him and have been writing to him about this issue, but that is no guarantee he will read it. If I call Social Services, he will likely leave the house when they show up. So there is not a lot I can do. I don't believe he qualifies at this point anyway. The other thing is that he thinks when he can no longer walk, he will simply get around on crutches! So no need in his mind for any help.
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What you do is let him be and check on him periodically. Call APS, and you can do it anonymously if you wish, if the need occurs. They will check on him and if needed, they will take action to ensure his safety. That may include State guardianship. What likely will happen is he will end up in the hospital and then the social workers there will contact APS and he likely will be made a ward of the State. You do NOT have to take him in if you are not willing/able to.
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jolobo Jan 2021
Thank you, that clears up my question about APS. I understand that now.
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