How do I work out with the nursing home my mother's financial problems?

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My mother has Alz's Disease and has been placed in skilled nursing home care in memory care unit. Last month I got info. that Medicaid for her had been approved and would be paying for her care (Medicare stopped paying after 100 days). Then I got an email (I am deaf) from Business Office at that nursing home that I owed them $3361.00 (from her own SS checks which I had been in charge of). I emailed back in reply that Medicare and Plan D for Prescription drugs (UnitedHealth) amounts were already deducted from her SS checks totally $552.00 that should be deducted from 3361.00 as Medicare/Plan D would pay back. That I had to pay Mom's attorney 925.00 for lawsuit that her stepson filed against her to take her Life Estate. Her house was finally turned over to her stepson last August 19th. I had to pay expenses for her house before turning it over like property assoc. fees, taxes, electricity plus movers to move her stuff from her house to my place. But that lady at Business Office at nursing home replied back that it was not their responsibilities, that I am expected to pay that much amount. Mom has only approx. 600.00 left. Her SS check amt. is small. I just don't have money to pay them. Plus I realized that 57.60 has been taken out of her SS checks automatically for insurance for her car which I will go and cancel it tomorrow. I will appreciate any help I can get out of paying that much that they want which I do not have that much money without neglecting my rent, electricity, bills, etc. I get SSDI checks each month which isn't much. Thank you in advance. (Mom has a 10 yr old car which still runs good. My own car doesn't run even though I paid 945.00 last year to get it fixed.) My siblings live out of state and don't help with Mom's care so I have been doing this for 3 years now. I took care of Mom in my house for 2 and half years. Also her nursing home is 35 min. drive away, is too far for me. There are two good nursing homes very close by, but she's on their waiting list. Perhaps I should take her out and take care of her again until the one close by opens (one is excellent and is 5 min. away). Any advice?

Answers 1 to 10 of 22
Top Answer
Since she is on Medicaid, call the wefare office and explain the bill you got. I think that medicaid does back pay a month or two from date of approval. I wouldn't go into detail about financial things in the past. Just keep it simple to what is going on right now. Only discuss her financial business and try not to throw out to much of your financial situation. Because you don't want to be held liable to pay this. . So how can she pay if she has no money. That's how she qualified for medicaid in first place. If the welfare office won't help ask them to direct you to someone that can.
I already told that lady in business office at nursing home about Mom's expenses. I didn't discuss mine. She still insists on me coming in Wednesday to give her a full amt. of 3361.00!! So naturally I am freaking out! That amt. goes back to July & consists of 4 months of her SS checks. This doesn't make sense to me. I forgot to add: I paid 551.10 recently for Mom's supplement to her Medicare (Blue Cross Blue Shield) out of her SS money. I can't imagine having to pay 3361.00 which there is little money left. She did say she'd turn account over to collection dept. if I didn't pay this Wednesday.
I forgot to add: I didn't expect for nursing home to claim Mom's SS checks going back to July. I thought they'd start in September. So anyone reading this: be warned that amount of SS check is expected when you apply for Medicaid, not when it gets approved.
You are not responsible for your mother's expenses. I think at issue here is that you had control of her SS checks. The nursing home claims you should have paid them with those checks. You used them to pay other expenses of your mother's. Is that correct?

I think yellowfeever is on the right track. If Mom has a case worker or a social worker who helped with the Medicaid application talk to that person. Leave your own finances out completely but explain what you did with the SS checks and the situation you are in now.
Yes, I used her SS checks to pay for expenses of her house and her attorney fees plus things she needed like shoes (therapist's advice) to make it easier for her to walk, they were expensive, underwear, socks, robes, etc. Outings and gas expense for me to drive back and forth to see her (I see her 4 times a week and also take her home with me for her overnight stay on Saturdays.) I think it's a good idea to talk with a social worker at that nursing home, but I haven't met her/him so I don't know who. Only a social worker at hospital in behavior health unit before she was transferred to a nursing home. She was excellent!
Contact the social worker you already know, at the hospital and explain you'd like to ask some more questions about your mother's case. See if you can start there.
Medicaid decided how much of your mom's income will be considered her responsible portion to be paid to the nursing home. It is not the nursing home who makes this decision. Normally, if you are your mom's poa medicaid will send you a letter explaining what your mom is responsible to pay and when she was to begin paying it. You can appeal Medicaids decision, but it is extremely rare that they reverse a decision. Regardless the at this point the nursing home is due this amount as Medicaid will reduce what they pay the nursing home by this amount.

Sorry I don't have better news, but that is how the system currently works.
Coach is spot-on, There are really 4 issues here:

1. From the month she is accepted into Medicaid, her resources less whatever her state deems as monthly personal care allowance - which varies from $ 30 - 60 a mnt - all must go to the nursing home. SO if she has 800 SS & 1000 retirement
then $ 1,740 - 1,770 must go to the NH from the month she gets there. Some NH will prorate the first days to the actual date but don't have to if they take privatepay.
Sadly that means the $ you spent on other things for her you shouldn't have and it should have gone to the NH. If you signed her into the NH AND signed your name rather than "Jane SMith as POA for Ann Smith", then you signed off as legally responsible for the debt. Which did you do?

2. If her monthly medicare payment is being deducted from her SS - that amount is usually paid by the state if she is poor enough. This is about 88 a month - this can take 1 - 12 months to get resolved as the $ for it comes from different state resources. There is nothing you can do to move this if your state is slow on this reimbursement. So she will be in a minus catagory for that amount. The NH know this but again if they are not a non-profit, this can become an issue

3. If she has a supplemental insurance policy, like BCBS, that is automatically taken from a retirement account then that is usually exempt from being included in her resources. It depends on each state how this is viewed. You may have to write to have this reviewed/appealed. While it is under appeal, the NH cannot enforce billing you for the outstanding difference under federal compliance with the state run Medicaid program. Must be in writing

4. Filial Responsibility - 30 of the 50 states have filial responsibilty laws, which means children can be responsible for the debt of their parents. It's based on old English law from the 1600 & 1700 when there were still poor houses. Now most states that have "filial" on the books have it written weak and it is not enforced. But a couple of states have NH that use the law to "encourage" family to pay for NH charges. This has happened in Pennsylvania with actual judgements against family members.

I bet your mom's NH is for-profit and views every action from meds ordered to physical therapy as a profit center for them (through companies they own) so the $ they get for Medicaid for her room & board is just the start of what they can bill.
This is totally legal but it is a major conflict in my opinion.

GOOD NEWS: If you are just on SSDI then you are judgement-proof, That means that whatever they try to do to you legally they have no real recourse as the $ your get from SSDI cannot be seized. Not that this keeps you from getting collection letters as collection agencies are pretty ruthless.

My bet is that you will get the 30 day letter from the NH - which means you have 30 days to move her out or they will turn her case over to the local agency on aging or Medicaid ombudsman. This usually shakes $$ out from family. But in your case the $ isn't there. The NH doesn't know that. You need to let them know that in no uncertain terms.

Since you are disabled, I'd go to the meeting with a short letter saying you are not responsible for your mom's debts, you are only her POA and doing your best aftercaring for her for 2 years, that you do not have any disposable income as your only have SSDI. That the only option you see is for them to get paid over time by payment from the personal needs $ your mom gets every month to pay down the debt - say 50% of her personal needs allowance. If they are willing to accept that, then fine and you want it in writing. Also take a good friend to the meeting to listen & take notes for you. Good luck.

Then I'd still move her closer to you once that opens up.
How long has your Mom been in the Nursing Home. Was she admitted in late March or early April??

That lady at business office at that nursing home where Mom is was very nasty to me last Wednesday night. In front of other people in front desk! She demanded that I gave her 3361.00 right away. When I told her that I couldn't do that she got mad, said that I was stealing money from Mom's SS checks, threatened to turn me in to Social Security. I told her to go ahead! Due to my deafness she wrote me a page full, but grabbed it & crushed it before I could finish reading it so I left.

Next morning (thanks to this website) I called Ombudsman via relay service for Arkansas. Turned out she happened to have a deaf son & knew what I went through. She was very helpful. I told her the full story. She told me to go ahead and give nursing home a check of what's left of Mom's money in her bank from SS which is $1116.00. That Ombudsman lady in Little Rock said she will get in touch with Ombudsman in my area which is Hot Springs.

I emailed to Julia, an Admin. of Alzheimer's unit where Mom is & told her that I would not deal with that lady from business office, that I would now require them to provide me a certified sign language interpreter according to ADA (they'd have to pay for it.) I told Julia what I used Mom's money for, that I had paid for Mom's Blue Cross Blue Shield in advance for 3 months, that Medicare and Plan D took out money, etc.

I also requested to Ombudsman for a transfer for mom from that nursing home to the one close to me which is 5 min. away. She said that it would be so easy since Mom already had been approved of Long Term Care Medicaid which is transferable.

Anyway, to my surprise I got a check from Social Security office in amount of 322.00. It's a refund for Plan D (Prescription Drug Plan.) Got a letter from them.

How do I get refund from Medicare that still takes out 96.40 per month? I thought business office took care of it. I will call Social Security via relay service tomorrow to ask about it.

Amount has gone down from 3361.00 to 1923.00 so far. Still more to come from Medicare and Blue Cross Blue Shield (supplement to her Medicare) which will help more. Then the rest I will have to come up with from my own pocket.

To answer coach's question, Mom was admitted to nursing home on April 24. Medicare paid for it until July 22. I got confused, thought Medicaid would start to take Mom's SS checks in September when she was approved, but it goes back to July!

Again, warning: the moment Medicare stops paying Medicaid owns SS checks already, not later when approved. This was my mistake.

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