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Our LO is approved for Community Medicaid but her (elderly) primary caretaker is very reluctant to use the services. There are personal care aides coming now who being paid from a LTC policy-which he accepts reluctantly. We would like him to use the Medicaid services as well as the Personal Care aides as the LTC policy limits the hours they will pay for.


I was wondering if there were a list of the services that are available that we could review to see if any of them would be acceptable to him.


For example, before becoming ill, our LO exercised faithfully. Since diagnosis, her caretaker has not arranged for a way for her to continue exercising. Does Medicaid pay for any sort of exercise classes? How about house cleaning services or other home maintenance? The caretaker is trying to do everything himself. He feels very guilty about letting other people "do his job."


The Medicaid services of which I am aware (personal care, transportation, medical care) sound like they will help him keep her in her home as long as possible. Now...how do we get him to start using them? We have been advised that if he fails to use the services, her approval for them will be closed. They are in New York.

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Thank you, KathyB. Physical therapy might be accepted. It's more medical than intimate care. Maybe he wouldn't feel so much like he isn't doing "his" job.
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Hi Marcia;
When my mother was home with a community waiver from Medicaid, housekeeping, CNA, and physical therapy were all covered . She did not have a LTC policy, so, I can't reply to that issue.
I would talk to the case worker from Medicaid assigned to your LO, he/she will be able to help you.
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Thank you. The patient is safe now. The house is safe. We are trying to avoid having to line up Medicaid services in an emergency situation...such as caregiver illness...by encouraging them to accept the services now. My thought is that if the caregiver has even a short hospitalization, we'll have services in place to disrupt the patient as little as possible. We would very much like to keep her home as long as possible. She is in a moderate stage now. She can still do many ADLs as long as she has guidance and encouragement. For example, she can't put a meal together herself but she will eat food placed in front of her. She can't shower by herself but is able to wash herself if someone helps to remind her of all the steps involved. The caregiver feels like this is "his job" but has reluctantly allowed helpers to come in a couple times a week to help with personal care..hair, nails, that sort of thing. We were hopeful that they would accept the Medicaid provided adult care center and transportation. But they are unwilling at this point. I was just trying to find something else they would accept so that their application is not closed. If we wait until an emergency, it could take 90 days to re-organize Medicaid and might require adjustments to new people at a stressful time. I do not entirely know why the caregiver is so adamant about doing this himself. He did say "Family should take care of family." But there is no one ready, willing and able to provide the care he is currently providing should he fall. So we need a Plan B.
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I don’t think Medicaid will provide any services much different than they have now. Medicaid in many if not all states won’t provide a housekeeper for the entire home or home maintenance. Medicaid funding in all states is being closely reviewed to assure those receiving Medicaid are in need.
As suggested above there are many exercises seniors can perform, whether they are mobile or bedbound. Before any exercise program is started please check with the person’s PCP. 
If the 89 y/o caregiver is getting burned out, you may start looking at other options for the person’s care just in case the CG gets ill or debilitated themselves.
Is their home livable now? If the house needs repairs it may be time to place the person in a SNF.
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They have two hours per day of a care aide paid for by a LTC policy. (It will cover nothing in a residential setting, just 2 hours of home care.) We are trying to line up more services because the 89 year old primary caregiver is going to burn out. His cognitive skills are ok. He's just stubborn. I need to find something he will let them do now. Something he would want other than provide personal care to the patient. I'll ask the Aging life specialist we hired on Monday. Maybe she can suggest something.  Thanks!
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If I'm understanding you, you have Medicaid aides and private home health caregivers?

The private home health caregivers can be expected to do light housekeeping such as dusting, laundry (don't dump everyone's laundry on her but certainly the patient's laundry including linens), wiping down the bathroom (again, no scrubbing the floors on hands and knees), and get together a meal or two (no 5-course meals or cooking for outside family and/or visitors). "Light" housekeeping is just that. Light. This doesn't include home maintenance. The aide is there to care for your loved one, not be a maid/cook/carpenter. Her focus should be on your family member.

As for exercises, are there any instructions lying around from when your loved one had exercises before? Does your loved one remember the exercises she was doing? Either aide can take her through exercises but get doctor approval first. There are simple and basic exercises she can do in the meantime. Leg lifts. Rotating each ankle. Flex and point each ankle. You can roll up a wash cloth and have her squeeze this 10x in each hand. These are all exercises that don't require your loved one to get up. Check with the doctor for more comprehensive exercises.
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Have the caregivers cognitive skills been evaluated?

Are your loved one's needs being met? I didn't know you could have Community Medicaid while using an LTC policy.

Why will he accept LTC paid workers and not Medicaid help?

I'm sorry I don't have an answer.
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