I’m having a dilemma over Mom’s living situation.

First, a history: Mom is bi-polar and also suffers severe anxiety. She did really well with meds and counseling up until about 5 years ago. At that time, she and I think she went lithium toxic. Lithium is a mood stabilizer that can work wonders, but also is very toxic. Patients who take lithium need to have their blood levels frequently measured, to make sure they haven’t built up to a toxic level. Normally, she would have her blood tested every 6 weeks or so. But at that point she was going to a shrink at the health dept who didn’t seem particularly concerned with the whole lithium issue and was only having her do blood tests twice a year. She had already gone toxic one time previously without any permanent damage.

Mom and I would talk on the phone once or twice a week. During one conversation she told me she hadn’t been feeling well and was getting dizzy spells. The next day she told me she had fallen down at work, so I told her to go to the doctor. She did, and they didn’t find anything. A day later she sounded really out of it, so I decided I needed to go see her. I drove up the next day and when I got to her house she was disoriented and very sleepy. The next morning I awoke to her outside, in her pajamas, knocking on the front door. She didn’t know where she was or who I was. She finally came around and both of us were really scared. After several doctor’s visits I decided they weren’t doing enough and brought her back home with me (I lived 2 states away at that time). The shrink did admit that her lithium was at the “high end of therapeutic and different people vary in their sensitivity to it”, so I’m pretty sure she had gone toxic. Shit, she was so disoriented she couldn’t dial the fucking phone (and I’m talking push-buttons), and I could see her downward progression in her checkbook register which went from confusing to indecipherable. And the doctor was not concerned at all. He told her to come back in 2 weeks.

She ended up staying a while with family and getting some decent medical care. About a year later, she moved to the town where I live. It turns out she has permanent memory loss and some loss of cognitive function. Even now she gets confused very easily and often forgets things.

Since the episode 5 years ago she’s been in and out of psych units. In the past year she’s been through day treatment twice, an inpatient 4 or 5 times, and spent 6 weeks at a short-term facility. So after the last hospital stint, we decided she should try assisted living. Living alone is too isolating for her,and living with hubby and me just doesn’t work… we tried already.

The ALF she ended up in was recommended by the hospital social worker and turned out to be the only one she could afford anyway since they will take her disability check as rent. All other places we checked costed 2-3x more. She seems to have stabilized since she’s been there. She’s not on edge all the time and seems not to be depressed. But the place is a dive. In her first 10 days there the screwed up her meds twice. Once they mixed 2 into one bottle and another time they tried to give her twice the dose of 2 other meds. So I filed a complaint with the state and they were found in non-compliance with several issues. Now I find out that they’re rationing the residents’ meals, have fed them leftover spaghetti 3 times this week, rarely have fresh fruit or veggies, have a leak over the kitchen stove, and have plumbing issues. The kitchen sink has backed up over the food prep area and some toilets are less-than-functional.

So, what do I do with Mom? She’s going for surgery in a month or so and wants to leave the facility permanently when she does. But where does she go from there? We may be able to qualify for a free visiting nurse while she rehabs from surgery, but we can’t afford to pay one. I’m already paying all her bills and the rent on her home while she’s at the ALF. She has Medicare which only covers certain expenses, but isn’t “poor” enough to qualify for Medicaid or the other free/sliding scale services in our area. She also takes about $450 worth of prescriptions every month. We’re trying to get reduced prices through a local non-profit mental health organization, but it’s slow going and they have limited resources.

So, there’s my dilemma.