Short-term care covered by Medicare has ended and Medicaid hasn't been approved, but my father still needs Skilled Nursing Assistance. What do we do?

I had a similar experience, but mom went into assisted living after medicare's extra 20 days of rehab expired, not a SNF. If your father still needs daily nursing care (feeding tube, etc), then sounds like he should still be in a skilled nursing facility. The SNF should take him now, care for him now, and medicaid will pay for his care retroactively to date of admission when his application is approved. If immediate admission to a SNF is not an option, there should be several home health services available. Medicare will pay for home health services -- limited, but at least it is something. The social worker at the rehab facility should be able to put you in touch with reliable home health agencies who will evaluate your dad's daily needs and schedule visits. Also, Medicare will pay for durable medical equipment and you must GET A RECOMMENDATION / PRESCRIPTION in your dad's medical discharge records for this equipment from the nursing supervisor at the rehab facility. Ask for a Wheelchair, rolling walker, toilet grab bars, and a hospital bed. You must request that these items be prescribed in his records! Medicare will also pay for enteric supplies for his feeding tube, etc. The nursing /rehab supervisor at the rehab facility should tell you about all of this stuff, give you home health agency recommendations. I only learned about these things from my mom's recent experiences. You have to be constantly overseeing your dad's care, and I know how stressful this is. Call your local Area Council on Aging and get some recommendations for a Geriatric Care Manager, who can help coordinate all of these circumstances for you.

Have your physician prescribe Home Health Services. It isn't as good as daily physical therapy, but it is something. I have had non-stop Home Health Services for the last 3 years after a hospitalization left my mom weak and hardly able to walk. A home health agency can come into your home and give physical and occupational therapy plus a nurse and an aid to bathe the person. Their criterion for continuing services is that the patient must show improvement.. I've found that all agencies work with this because they want the patient to show improvement so they will get paid. Their services are time limited. My current agency has provided my mother (and me) with a physical therapist who has come 3 times a week for 2 months, an aid that bathes my mom 3 times a week for 2 months, a nurse who provides bandages if needed. My mom doesn't need occupational therapy at this time. But that is about 5 or 6 hours of work that I don't need to do every week. After 2 months they will drop down to 2 times a week for about 6 weeks. If there is a fall, the services will increase to 3 X a week again. If not, we will be discharged at the end of the last 6 weeks.

Then I call my doctor who prescribes home health again. And another agency comes on board and starts all over. There is no relationship between the care she has received for 3 months and the next agency.

It is great in many ways. It takes some of the burden off of me and it also gives my mother the stimulation of these relationships. I have cycled through most of the agencies in my city. I have a few favorites that I have had 4 and 5 times.

it helps.
Best of luck to you.

Thanks CaraMia, appreciate the good comments. When I first read this posting I said under my breath "welcome to aging parents" no one cares, its all on our shoulders unless you parents are poor and/or not until they are poor.And, even then, do they get the true care they deserve when they are covered? Few have had an irrevocable trust in place 5 years prior and thats they only way out that I know of. Cheers to all of us caregivers!! I am pretty sure I now have to leave my job to care for my Mother, as there isnt enough money for me to work and pay a caregiver, yet its over by $300 a month to not receive medicaid.

Where is the nursing home social services/administrator? They are able to assist in your situation. And, no, your Dad will not be released from the nursing home unless I do not know all the facts. Medicaid will pick up reimbursement to the nursing home for each month your Dad is there and not able to pay privately. Contact your state Ombudsman to assist you. Be sure you have all your Dad's finances in order to prove your case.

Speak to the social workers at the SNF. They are experienced in advising what to do in situations such as this. Also check with your County, there is usually a "Council on Aging" or "Senior Advisor" that can assist you in this situation (no fee). Hope this helps. I'll keep thinking. Good luck!

luvmom, you are so right that the system fails to provide any real help to stressed out caregivers until all the money is gone, as you have said. Hang in there! The advice given by Mr. Robbins is important because nursing homes have the right to discharge residents with proper notice and there is little recourse when that happens other than to start over - yet again. Lots of wisdom shared in everyone's replies to your post, re946. You're between a rock and a hard place like many of us who are caregivers. I wonder if Centers for Medicare and Medicaid Services even cares about the plight of caregivers?

Yup. You have to be destitute to get help. But once you are destitute, it's not equal care for low to no income people vs wealthy folks that have long term care benefits they paid into. Or should I say, the long term care benefits they could afford to pay into? This country isn't doing well for its poor elderly and disabled. I doubt the good 'ole USA will ever take notice of this minority group because it's members die off or run out of steam (exhausted caregivers eventually fall prey to their own illness/age related problems and require care themselves.) But, maybe one day somethings gotta give...

Follow-up to previous answer: If you dad is a military veteran, he can also tap into assistance from the Veteran's Administration, in the form of a pension for assisted living or nursing facility care. This application also takes a long time to process, but it pays retroactive to date of admission to an ALF or SNF. Check out the Department of Veterans Affairs website, look for EXAMINATION FOR HOUSEBOUND STATUS OR PERMANENT NEED FOR REGULAR AID AND ATTENDANCE forms and instructions. see http://www.va.gov/vaforms/search_action.asp?FormNo=21-2680

Relax and take a deep breath. It isn't all doom and gloom. I have never heard of any application taking a year to get approved unless someone is trying to hide assets. If you are not comfortable with the Medicaid application process, comsult an elder law attorney. This is their specialty and might even be able to save some of the assets your Dad worked a lifetime for.