Placing a Loved One with Huntington’s Disease
By Katrina Hamel
In January of 2009, I started caring for my mom in my home, after years of her being homeless, ill, unreachable and 3,000 miles away. At the time, I was so glad to have her at home that I did not even consider placing her in a care facility.
Between 2009 and 2012, my mom’s psychiatric and behavioral issues became a big problem for her and for my family’s day-to-day life. She also had some of the worst chorea and eventually dystonia that I have ever seen. She would become very angry and would throw things, hit and scream. She also had paranoia and delusions that must have been terrifying for her. I had always wished that I’d found her sooner, so I could have gotten her in to see an expert in Huntington’s Disease, thus avoiding some of the pain and sadness that can come along with being unmedicated when you need medications. Some days were really hard, and I lacked resources in my area and knew no one else going through anything similar.
I had always thought about the idea of placement, but most of the time, I had too much guilt to actually “try hard” to get her placed. By that, I mean that I would call places and ask simple questions about cost, insurance, and Huntington’s disease experience and history. In doing this, I realized that the intake offices in very few places knew what HD was. I would guess that I called around 15 different homes that were near me, and out of those care facilities, two places had heard of HD, and one place had someone for a brief stay, but it had been years ago. I thought about how hard this must be for families who have nowhere to go, no places that know what HD is and how to help them. I remember thinking, I am a caregiver! I can do this! I can take care of MY mom! But at what cost? The attention to my kids, my job, the cleanliness of my house, my own health, sleep, the list goes on.
My background, before hands-on care of my mom, was in caregiving. I took care of people that had Alzheimer’s, dementia, and chronic diseases. I also specialized in Hospice care. I worked in care homes, and I also worked in people’s homes that wanted to stay home versus go into a care facility. Nothing could have prepared me for caring for my mom, though. HD is a whole different type of care that requires endless amounts of patience, acceptance, strength, disassociation, and the ability to continue day after day.
The bad days were bad, hitting, pushing, screaming, yelling, cursing, throwing food, falling, not bathing, spitting, talking to the dogs, paranoia, delusions, throwing excrement, screaming for someone to call 911, saying vile things to me and my family, breaking things and hurting herself. Good days didn’t happen in my home; good days were defined as only two or three of the above situations happening instead of all of them. I remember not even being tired at one point; I was on auto pilot; I survived, and that’s how.
My mom had always refused care from a primary doctor, a neurologist, a psychiatrist, even an eye doctor at some point. I called the police on her, in hopes of creating a paper trail for when the time came that I would be forced to place her involuntarily. She went to the ER one time, and the social worker told me that basically she was my problem, that my mother declined placement, and that she said she was fine living at home. I tried educating this woman about HD and how things may seem fine, but they weren’t. I also told this woman that I would not be picking up my mother, that they needed to help me with her care and medications, etc., before she came home. That didn’t happen, and I ended up having to pick her up.
Fast forward – I took my mom to the store for our routine monthly trip, and at some point, she decided to jump out of my car, screaming and yelling. I had my son in the car, so I had to go park and get her out of the middle of the road because she couldn’t walk well. She managed to walk/crawl/stumble into the nearby liquor store and was destroying the inside of the shop. She was screaming to call 911. So we did. I explained on the phone that my mom had HD and what that meant. They, of course, had no idea what I was describing, so I did ask for the psychiatric team to accompany them. The police came, and so did the psych team. I talked to the woman about my mom and what had been going on at home and the fact that I had been reaching out to every agency I could think of, to no avail. She saw that I had a child and knew that there was no way my mom could continue living with us without having medications on board.
My mom stayed in the hospital while I called all over Santa Barbara County and all of California, really, looking for a home that would take someone with combative behaviors and that has Huntington’s disease. I found no one willing to do so. The social worker told me that she would be releasing my mom. When I said she couldn’t come home, she replied, “How would you like it if your mom just wandered the streets of Lompoc?” Back then, I was a lot less informed about what should have happened in this situation. I said that the hospital, and more specifically the social worker, would be held liable if anything happened to her. This woman began looking for a facility to take my mom. Eventually my mom ended up in Los Angeles, which was 4.5 hours away from me and all of her family. When I walked in, the smell of urine smacked me in the face, a man was screaming and walking into a wall, there were three caregivers watching TV and ignoring everything around them. I knew I wasn’t happy, as my standards for care are pretty high. My hope was that she could get on some meds that would stabilize her, and I could get her moved closer to home or even back into my home.
Over the next several months, my mom would do well on the medications they were giving her, and we visited as often as we could. Some days, she would refuse her medications, and they would have to be forcibly given. This opened my eyes to the fact that she needed to be in a home that could provide this type of care. I would visit, and she seemed to become more and more submissive, almost defeated. Slowly, I realized that she was progressing pretty quickly. I then moved her to the care home I worked at that was for low-income people on Hospice. I was able to stay with her every day, sleep in her room next to her, and regain the love that was always hidden by daily caregiving and HD. She died 11 days later.
Tips to Help with Placement
I’d like to share some key knowledge that I have gained from my story and the stories of other people that I have helped with placement.
Since 2012, I have helped several families find placement for their loved ones. Here is a list of factors I found to be the most important to consider and talk about:
- Insurance/veteran benefits
- Financial obligation to the family
- Distance from home
- Quality of care
- Stages of care, through Hospice?
- Knowledge of and willingness to take someone with HD
- Do they have any waivers available (for someone that is young?)
Start by getting a notepad and writing down the names and phone numbers of facilities in your area, or the area of interest. Have a list of questions that you want to ask and start by asking to speak with someone in the admissions office. If you have insurance, I would start by asking a care facility if they accept your insurance, and if so, does that cover all the cost? If it doesn’t, what will be the monthly cost that the family needs to come up with? At this point, if there is a financial cost that you or your family will not be able to afford, I would ask about financial assistance. I would also reach out to your loved one’s branch of armed forces if applicable, to see what is available. With each question, you will see if there is any need to move on to the next question, or if it’s time to move on to the next facility.
I would then start talking about Huntington’s disease and listen to their reaction. Sometimes people have no idea; sometimes they are almost an instant no. Other times, they have had someone with HD and are willing to take someone else with HD. Be ready to talk and educate, if they are willing. You are also welcome to download our brochure (https://help4hd.org/education-resources-information/) What is Huntington’s Disease? to have facts to support your conversation.
Something to remember is that “no” doesn’t always have to be accepted. You can still ask if there are any ways around it, if there are exceptions. In many states, in the care home world, they are licensed to care for certain populations, and sometimes this includes only adults over the age of 55. A lot of times, our community needs care prior to age 55. Each facility that has this particular license also has a certain number of waivers that allow them to care for a handful of people outside of their license. This is where younger adults with HD that need care will typically fit into.
Something to consider is, do you want to ever have to move your loved one once he/she is placed? When I placed my mom, I was glad to know that they did offer end-of-life care; even though my hope was to bring her closer to home, it was nice to know that I wouldn’t HAVE to move her. If you do not want to move them again, an important question to ask is, “Do you offer Hospice care?”
If you live near the care home you are looking into, stop by for a visit. Try not to judge the book by its cover, and introduce yourself to the caregivers in the home, if possible. Oftentimes, care homes that have the nicest, most loving people working there don’t always have an updated facility. But would you rather have great quality of care or an aesthetically appealing building?
Some important tools to have and use are social workers who have experience with placement and HD. Even if your loved one isn’t being seen by a specialist, you can reach out to your local Center of Excellence and request someone to speak with. I think having someone as support and backup from a Huntington’s disease organization can also be helpful, someone to help you navigate your specific situation. For whatever reason, sometimes care homes listen to social workers or advocacy groups more than the families, though we all know that the families are the experts! Last year, I helped a woman with placement after her family found me through Facebook. She was no longer verbal, mainly bedbound, and the family was low-income, with only state insurance. They had tried many different homes and were turned down because she had HD. I started to help them, letting care homes know I was part of an advocacy group, trying to help a family survive, as the husband needed to get to work and was having trouble caring for his wife. I would get the same story, and I started describing the care that this woman required, that she hadn’t been combative in over a year, and that she was quite docile. After talking to them about her needs, they were open for more discussion. I asked them about their waiver count, and they had two waivers available. Slowly, the process began to move her into a facility that benefitted her and her family.
Sometimes, I have helped families in situations that didn’t work out as easily, and they had to struggle before we came up with a plan.
Don’t lose hope. Do your homework and gather a team of soldiers to help you battle and advocate for you and your loved one.
Katrina Hamel is the vice president and CFO for Help 4 HD International Inc. She is currently caring for one of her brothers who has HD. Please be sure to tune into Help 4 HD Live! on Wednesday, June 13, at 4 p.m. ET/ 1 p.m. PT to hear Katrina talk about the challenges of placing someone with Huntington’s or Juvenile Huntington’s disease. You can listen to the show live (or in the archives after June 13) at http://www.blogtalkradio.com/help4hd/2018/06/13/challenges-in-placing-our-loved-ones-with-hd.