Long-term supervised psyc care

Because of bi-polar/suicidal ideation issues, my older sister can no longer live on her own. She's just been admitted for the 4th time in less than a year to Columbia-Presbyterian's psyc unit. She's ok and actually happy to be in a safe environment, where taking her complicated meds is supervised and where there's some structure to her days. I need to find a long-term supervised residential solution for her and I'm hoping someone on MOL can help point me in the right direction. Here's what I'm hoping to find: 

My sister is a life-long New Yorker, so the closer she can be to the Upper West Side, the better.  

She's in her sixties, but not in need of dementia care. She's fully compliant when she's in the hospital; she just can't manage on her own. I don't think a visiting nurse/caretaker would keep her safe - she's not ok when left to her own devices.

I can't say money is no object, but she has a small income from her dad's family (she's my half-sister). So what I need isn't indigent care but not those ritzy asylums that advertise in the back of the New Yorker mag.

Any thoughts? I don't know if this type of care exists but if I feel that if I don't figure something out, she'll be back on the GW bridge trying to throw herself off.

Columbia Presbyterian's psych unit probably has a social services department.  Start there and ask them for recommendations. You can also call her insurance provider to cross-reference names and get LONG, DETAILED descriptions of what kind of assisted living situations they might help pay for.  

Another amazing resource is the Columbia University/ New York-Presbyterian/ Weill Cornell Medical College up in White Plains. It is like a Disney Land for behavioral health issues. Well worth a series of appointments and a trip up to visit in person. 

They cover it all and they can direct you to the best systems of support when its time to strike out on your own.

Good Luck

Your sister is a confirmed New Yorker..........that will never change.   But perhaps you might use this facility for a few months

Wonderful setting and warm caring counselors..........They did wonders for an in law of mine.   Might help for a few months

while you seek the right  pathhttp://www.spiritofgheel.org/

I'm sorry your sister is struggling. I live in MW and work for a boutique Estate Planning & Elder Law practice in NYC and we have clients in very similar situations. The right solution is likely a bit more complex than just getting her into a not-so-fancy (expensive) assisted living facility with medication management. There are issues of guardianship and Medicaid/Medicare planning that should be addressed ASAP, in conjunction with finding her an appropriate placement. Feel free to call me if you decide you would like to assist her with this, Tara @ cell 201 926 8787.

Thanks for these suggestions! They're all helpful and I'll bring them with me to a family discussion about what to do next.

It seems that for now at least, Medicare is more likely to pay for a medium-term placement rather a long-term or permanent placement. From what I've heard, they'll take small steps before committing to anything more restrictive, and expensive.

I am not an expert because my daughter is still a minor, but you will probably need to learn about all the social service systems. Like can she get SSDI? Or SSI?  My impression is there is not so much in the mid range. Anything private is incredibly expensive, and most middle class people will need all the financial assistance they can get. At this stage, check out every social worker or case manager you can find. As to the referral to Payne Whitney/ Columbia P, there are highly reputable (and seem to have some heart), and may be able to direct you. 

Thanks, Gerryl.

It turns out that under Medicare, you get 190 days of psyc hospitalization. Total. Per lifetime.

Is anyone else surprised by that? You get unlimited inpatient care at a general hospital, but for mental illness, it's capped at 190 days, and that includes disability or SSI/SSDI. So the oldest and most fragile people are left with, what?

Luckily, my sister has enough money to be able to pay for a place like Spirit Of Gheel (thanks, @author!). Assuming she doesn't live a very long life, and her money is invested wisely, and the hospital doesn't raise its rates by a lot..

And FYI, for others in our position, there's a website http://www.artausa.org/ that has a directory of really reputable long-term psyc care places. Many of the places are upwards of $15,000 per month, but there are a handful at under $10,000.

Rivoloii...........just a note that may help.  When my in law entered Gheel  his assets and income covered  him  for what would  have amounted to an 8 year stay.   Beyond that I thought I would have to do some fancy investing.

However we were told by those in charge that once someone is accepted at Gheel.........that status is not automatic ............they would be retained there hopefully using grant monies and whatever was available.

Unfortunately my in law had cardiac problems which the VA hospitals never fully explained to us and we lost him far before that 8 

year mark.

The hospital should have a social worker who is probably billing for not providing this service like they are supposed to......part of their job is to make sure the person has an appropriate environment to go to once discharged (which can be their home, a homeless shelter, or a supported living placement, etc).

NJ has various supported housing programs including group homes.....Likely there are long wait lists to get in.

if she is that disabled, she would be eligible for SSI and medicaid if she has limited resources....if she has financial resources, they need to be put in a special needs trust or one of those new ABLE accounts (I don't know much about those yet)...

group homes are state funded/paid for by medicaid.....

she may have to use any resources not in a protected account 1st....and then other funding sources such as medicaid would take over

if she cannot live independently, she can be kept in a hospital until a placement can be found

contact the county state/mental health department and ask how you get her on the supported housing list....

also...there are 'psychiatric day programs' also known as partial hospitalization which run about 5-7 hours per day 5 days per week...that may help her

people needing home health care/supervised living may qualify for a specialized medicaid program that picks up where medicare leaves off.....once you go through the assets.....