My 88 year old mom has been in a county funded AL place for the last couple of years and her care is starting to overwhelm the facility. She recently started refusing to get out of bed to go to the bathroom.

If the facility decides they can no longer care for her--which I fear could happen before her Medicaid application is approved--but it's not an emergency, I know my only option is to take my mom to a hospital myself and leave her there--I cannot take her into my home. My question is, if anyone has had to do this (and I'm in Maryland, btw), what is the procedure? Do I go into the ER? Is there a department that usually deals with this sort of thing? I have POA, but I absolutely don't want to sign anything. Please help me be prepared if this situation occurs. Thank you.

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The AL could call for an ambulance or EMS to take her to the ER for an evaluation. The issue then will be IF the ER places her for “observation” status or “admits” her for hospitalization.

For MediCARE to pay, she needs to be admitted for hospitalization and if it’s an hospitalization of 3 days or more she can be discharged to a NH for “rehab”. So she does not go back to the AL but instead to a NH that has a rehab unit. Medicare rehab benefit covers 20/21 days and the usual path is that they do not ”progress” sufficiently in rehab to stay on Medicare so segueway to becoming a LTC resident in the NH and file for LTC NH Medicaid. By doing it this way, she comes in with a fat medical chart that shows she’s “at need” for skilled nursing care. The NH is happy as they have her stay paid 100% by Medicare for first 20/21 days and perhaps a few days beyond that if she’s progressing (like triple what Medicaid pays) and then they have her there as Medicaid Pending but showing “at need” medically so no worries about the medical necessity requirements from Medicaid.

I’d suggest you try to have a calm clear talk with the SW and nursing staff at her current AL as to how to best approach doing this.

LTC NH medicaid is slightly different than AL Medicaid as AL Medicaid is done via a waiver program. So you may need to find additional documentation for the NH application.
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Sounds like the process of moving has begun. Nursing home take new residents in with Medicaid pending all the time.
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People transfer from AL to nursing homes all the time without having to detour to someone's home along the way, I would start talking to the facility about how to get this process started. Have you picked out a nursing home you prefer?
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Who is looking after your mother's health at the AL?

I think I would be proactive in getting her seen by a doctor to investigate the reason she will no longer get out of bed. Has anyone checked for fractures? For a UTI?

You would be, in my opinion, completely justified right now in having her taken to an ER to look into this sudden change in mental and physical status.
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