This situation involved a young couple who called me as a
referral by a nurse colleague, who knew me from a previous client. I met with them
in their home and the woman said, Were taking care of my father.
They struck me as being kind of young; in their late 30s. We met in their house and
the father lives downstairs, and they have a 7-year old son and in addition she was about
6 months pregnant at the time. She has since had the baby and everything is fine.
They called me thinking that they really didnt need too
much, and since theyre personal friends with this nurse, she told them to speak with
me. They just wanted to hear what I had to say and if I had any ideas that could
help their situation. I spoke with them first and then I met the father. My
immediate reaction was how can they possibly do this with so little help. They have
one child; are about to have another, and theyre running up and down the stairs all
day long taking care of the father. Hes got dementia, is defecating on the
floor, and hes got no understanding of what his limitations are, so at any moment he
can jump up and fall down. Hes very nasty and hes not
receptive to having any caregivers, paid or unpaid. Im struck by how
little help they have and how they can possibly do this. I tell them I really think
this is heading towards a crisis, if it isnt one already, since shes about to
have a baby. From my perspective it doesnt quite make sense, You could
have round the clock care almost immediately.
I then talked about Medicaid planning and they thought,
Thats interesting. We want just 8 hours. They started with
that and it eventually increased to full-time care. We ended up talking for about 3
hours, and it comes out that theyve been taking care of this guy for three
years. They rescued him from the other daughter who was about to abandon him, and
then bought a house that could also accommodate him, and theyve done this for this
for three years. Then it comes out that what they really wanted, but were feeling
helpless about because they had tried and didnt get anywhere, was to place him in a
nursing home because, in fact, they couldnt care for him. It was a tremendous
drain on them, emotionally, and in every kind of way; it was just too much.
From their initial presentation of were doing fine,
we dont need that much help, progressed to, in fact, that we need more
help than we think is available, and its kind of hopeless and were just stuck
here. Were just going to plug away and do the best we can."
The first scenario was if we can get all this home care,
lets do that. And then, a couple of months went by, she had the baby, a new
crisis developed. He went into the hospital, and they thought, we can place him in a
nursing home right from the hospital. And they thought it was all set because the
doctor assured them he would get him into the nursing home where he, the doctor, worked.
But the Medicaid situation fell through because they didnt present the facts
to the nursing home Medicaid worker the right way.
I reviewed the Medicaid situation in terms of the nursing home
perspective, and I saw that he was eligible, but I could see where it needed to be
presented differently. It was somewhat complicated, and needed to be presented by a
lawyer, not just a social worker, because they wouldnt buy it from me. I
said, I know this great lawyer, and he will present the facts in such a way that the
nursing home will agree that there is no risk that Medicaid will be denied, and
theyll probably admit him before the Medicaid is approved, on a Medicaid pending
Sure enough, we met with the elder law attorney, and I presented
the facts to him. It was crucial for me to be there to present the facts in a way
that was relevant for what he needed to know, so that he could say that this was a sound
way to proceed. He reviewed the facts of the case while were all sitting there, and
he said, This is fine, and Ill take care of it. And, sure enough,
within a couple of weeks, it was all done, he was placed in the nursing home and they did
not have to lay out any money, because of the Medicaid pending status.