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One person told me the nursing home was taking money out of that 50 stipend for adult diapers, toilet paper, Kleenex, toothpaste, etc. And way overcharging. She had to go and buy all those items, present the receipts, and get reimbursed for them. That was so her mother would have some money left over for haircuts, etc.


She was on Medicaid.


My Dad’s SS check starts getting deposited next month in the nursing home. We are curious about this.

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Spore1941, yes it's Medicaid. We didn't have the nursing home make the Medicaid application. We had an Elder Law attorney. My FILs SS goes into his bank account just like it always did. We pay the NH the amount Medicaid says is his monthly liability, and don't let his account balance go over $1500.
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This rule about the $50 stipend is being made by Medicaid. It is my understanding that the nursing home cannot grab this money for anything. This money is for clothing, haircuts and stuff like that. If your dad is on medicaid, I would check with medicaid about the rules for the stipend. Some nursing homes will try to grab this money in defiance of the rules.
If your dad is not on medicaid and is self paying things are different. I had one loved one in this situation (self pay). We were visiting her once a week and taking a box of tissues every week. We put her name on the box in sharpie. There were several boxes piled up. The first month there was a bill item for tissues. There was also a bill item for gloves unspecified number of gloves. I took a camera and made a photo of the tissues we had brought. I wrote a letter telling them to remove the tissues charge because we had photo evidence of our supplying tissues. Here's a tip: use you cell phone to take photos of everything. I asked them in the letter to tell me how many gloves were in a box and how much each box costs. I did the math. They were claiming to have used 26 pairs of gloves everyday for each day for the whole month. No they didn't! I called them on this. They said Oh that's a typo. Notice everything I did was in WRITING. Very important, document everything. These people never again tried this nonsense with us. You should have yourself as payee for the SS check. Go to the SS office to set this up. Under no circumstances should the nursing home be the payee for that check. They will take severe advantage of your dad.

I have had loved ones in assisted living and memory care. They routinely try to bill for wipes, toothbrushes etc. Their charges for these items are so very high. I don't know what a $6 toothbrush looks like but it better be gold plated. I supply all of these items for them. I document the supply with photos and a written record. Once I complain and include some cell phone photos, they realize they can't put one over on me. The charges stop. Please pay attention to what these people are doing, don't just trust them.
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Cinderella5001 Sep 5, 2018
I very much agree with what you have written. Although we were private pay, one nursing home coerced me into having the social security payment go directly to the nursing home. It was NOT required. And it took me a long time to unravel that with social security. I have very few good things to say about nursing homes. You were smart to keep the records you kept. I also used my cell phone to document what I saw in the nursing home. I even took pictures of my mother, her food tray, the condition of her room, her wound dressings, bruises on her arms, etc. so that I had solid évidence of things that happened. It is good advice to be alert. Sometimes, an elderly parent can't really tell you about the things that happen there.
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Health, the facility should send you a list of all the expenses at least every month. I always got a rundown of my mom’s personal needs account, including the withdrawals she made and what she spent at the beauty salon. You should also get a rundown of all the meds given. Pay attention to both these forms. Not because the facility is bound to try to scam you, but because you need to keep track.

This is not a reason to dump the facility. The kind of care your dad gets is far more important than the nickels and dimes of his personal needs account. Just be aware.
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We also pay my FILs nursing home from his own bank account. I wouldn't entrust the NH with it, especially because my MIL, the Community Spouse, is entitled to some of his SS, which we transfer monthly to her personal account.
I've noticed that their billing is sometimes erroneous, and we pay them exactly what Medicaid says we owe, plus incidentals they provide, like haircuts, etc. Then, they just have to figure out how they billed wrong and correct it--we don't mistakenly overpay their incorrect billing.
Also, I know of a case where a NHs bookkeeper stole about $40,000; and I suspect it was from the residents' personal needs accounts. If no one is watching, bad people can take advantage.
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Spore1941 Sep 4, 2018
Is this Medicaid?
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I am glad your dad is enjoying his new place. Please keep an eye on him to insure that he continues to be treated correctly.
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Toadhall Sep 2, 2018
Absolutely! I have had the care of several relatives. I would make regular visits and also random visits to see what's going on. When they see you popping in at all hours, I believe your loved one gets better care. The staff may be doing this unconsciously but I believe having someone visit keeps them on their toes.
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The $50 is used for incidentals, e.g. personal effects.
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Reply to Llamalover47
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Thank you for all your answers. I finally made it back to Ohio. The 50$ per month in Dad’s personal account at the SNF is his to spend as he wishes.
He will start having his Social Security check deposited into the nursing home and that 50$ per month will build up if he doesn’t use it. He likes to shop in their little store as he can get Pepsi for 50 cents a can. And there are some vending machines he can get snacks from.
Everything is covered including cable. Only thing not covered is phone. Medicaid provides a free cell phone with so many minutes per month on it.
All is well.
We can breathe again.
He is safe and settling in. Today staff kept saying everyone loves him. He goes out into the courtyard and sunbathes everyday, with his cap, shorts, and sunglasses on.
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igloo572 Aug 30, 2018
Prairie- take a picture of him “sunbathing” and keep a copy with you so that whenever you feel angst on the move Or somebody gives your grief on your not caregiving personally for him in your home, you have the photo to have a moment of zen.
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My mother was in a skilled nursing facility, on Medicaid, for 2+ years. My sister is now in skilled nursing facility pending approval for Medicaid. The $50.00 is for personal use, haircuts, movie, whatever. Anything the resident needs for daily living is covered by Medicaid. For instance, my sister needs adult diapers, the facility provides them, however, my sister prefers another brand, so, I provide them. We never deposited the SS check to the nursing home. The checks were deposited in their own bank accounts, and I pay the nursing home from that account. I have POA for my sister, as I did for my mother.
I hope this helps.
Stay strong!
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Reply to KathyB1125
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To answer this question I would need to know if dad is in a skilled nursing home (private pay or Medicaid) or an assisted living facility.

If he is in a skilled nursing home then usually the cost of toilet paper, Kleenex and toothpaste should be covered in the daily rate. The cost of diapers would be covered under the per diem rate if the individual was on Medicaid, if they are not on Medicaid then it would be an additional charge. You have a right to have all the charges explained to you. I would also ask for am itemized statement that shows all charges, the home must provide this upon request.

If your loved one is in an assisted living facility they may charge for those items. Again the facility should tell you upfront what they will cover and what you are responsible for. Ask for a list of covered items.

You do have a right to shop around and find the lowest cost for personal items for your loved one. Many homes will require you to purchase the items and then present a receipt to get reimbursed.

As far as the Personal Needs Allowance (PNA) the nursing home or assisted living facility can NOT use those funds without permission from the resident or their legal representative. Most residents use their PNA for beauty shop appointments, for personal supplies or snacks.
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Toadhall Sep 2, 2018
I know for a fact that Medicaid covers adult diapers in my state. This would be for a person of any age living anywhere.
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The family can ask for a list of what is included, but, I've never heard of a facility charging a Medicaid patient to pay for toilet paper or soap. That sounds like something that would be included with the facility cost. And, adult diapers should be covered by someone, if the person is incontinent and there is a doctor's order for it. Check with facility or the Medicaid case worker. I have always purchased the toiletries, clothes and miscellaneous items for my LO from her personal needs allowance fund. It covers her haircuts too.
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I know that all nursing homes are different....I regretted sending my mother's social security to the nursing home. It took me a long time to reverse that. We were always private pay, so in my opinion there was no reason for the nursing home to receive her social security payment.

Secondly, the trust account that I set up with the nursing home was used only to pay for my mother's weekly beauty shop visits. I provided everything else.

Also, I found that if I brought, extra supplies, like facial tissues, lotions, adult diapers and even snacks, they seemed to disappear very quickly. Since I visited almost every day, I decided it would be better to keep the "extra supplies" stored in my car.

In addition, I did my mother's laundry myself as I found that the nursing home laundry absolutely destroyed her clothing. You still have to label clothing but if your parent has nice clothes/outfits to wear, you will be happier if you take the time to do the laundering yourself. (By the way, we did the same for my father.) Yes, it is a pain in the neck but I always liked my parents to look nice in the nursing home.

Another suggestion, if you have spécial outfits for your parent to wear, take them home. Sometimes nicer clothing seems to "disappear".
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Toadhall Sep 2, 2018
I do laundry for multiple elderly relatives. I feel like I'm running a laundry service, 16-20 loads a week at least. They always look nice and their clothes last much longer. I was not having my relatives wearing stained and wrinkles clothes. As power of attorney I am responsible for keeping them in the manner to which they are accustom. None of these people would ever have consented to look like slobs. Stuff can disappear. In memory care, I have found other female residents "shopping" in my relative's closet.
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Go talk to Social Services at the Nursing home .Ask for a print out of all charges,instead of hearing from someone's mouth.
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health2018 Sep 1, 2018
Are you saying that I should ask to speak to Social Services at NH for printout of all charges before committing/deciding whether or not the particular NH is the right place?
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Here,s a summary

cga.ct.gov/PS99/rpt%5Colr%5Chtm/99-R-0025.htm

There is nothing about the NH having to provide, diapers and toiletries. But it does say that only the resident or their representative can sign off on its use. Personally, i wouldn't want to be purchasing these things and find they were being stolen or used on other residents. But like I said, where I live no NH has you pay for diapers, tissues, toothpaste, etc. To be honest, I had a hard time getting the facility to use Moms stuff.

When Mom passed she had $200 in her acct. As Executor I was given a short certificate to handle Moms estate. I gave a copy to the NH who, after a few days or so, issued me a check in my name. The money does not go back to SS its considered part of the estate.
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Ahmijoy Aug 28, 2018
That’s interesting. I don’t remember getting a check from my mom’s NH. I thought it went to Medicaid. Hmmmm.
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I have never heard of this. And if it was done, it was illegal and should be reported to SS. The NH has to have authorization to deduct from that money.

When Mom went to a NH $50 of her SS was put in a Personal Needs Account that the NH oversaw. This money can be used to buy clothing, snacks, cigarettes, haircuts, etc. The NH had Chinese night and they had me sign it was OK to deduct the cost of the dinner from her PNA. Being a Medicaid patient has nothing to do with it. My Moms NH provided all her diapers and toiletries. In my area, I know of no NH that doesn't provide these things.

Now, was this person really talking about an AL? That would be a different thing since they don't provide personal needs. But then again, without written permission they should not be deducting from the PNA acct.

This is a good question to ask the NH. The only way I would think the NH would get away with this is if the State had guardianship. Even then, they shouldn't be allowed to deduct for toiletries that they should provide.
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No, no! She doesn’t pay for incontinece supplies! Hubby is on Medicare and Medigap and when he was in the NH and rehab, everything was provided and we took the unused stuff home when he was discharged.

Also, watch the balance of his personal account. When it gets too high, withdraw funds to get it back down to below Medicaid allowance level. Buy him a pair of shoes or something. Save the receipts.
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Most if not all personal products should be covered in what the NH is charging. If you have access to it, it should be noted in the contract.
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That $50 is his PNA - personal needs allowance. He or you as his dpoa can spend it anyway he Or you want to as long as the $ is spent on him or his needs. Most use it to have a set barber shop weekly visit so that cost is automatically paid out of the PNA held at the NH.

That being said, IF you all have opted for the NH to become his payee for his SS or other monthly income so that the PNA goes into a personal trust fund account at the NH it may not be easy to get to if not used for an in-house service (like barber shop). Often you have to physically go to the billing office or SW office to sign out $ via a ledger to get cash OR present cash receipts for things bought for him and be reimbursed to the penny.

Just as an aside on this, you DO NOT, DO NOT have to have the NH become his payee.

Dad can continue to keep a bank account with his check(s) continuing to be direct deposited and you write a ck to the NH for the copay amount required as a exact $ amount as per the states Medicaid eligiblility letter sent to your dad / you. I did this with my mom for 2 different NH and the first one wasn’t happy but 2nd one was its your decision. In my experience the NHs will press heavily that it’s required or must be dealt with this way. Hogwash. It’s not, doesn’t have to be. Medicaid does not require this. BUT you have to send the copay check like clockwork. Any late fees are on you and if it’s late NH can contact Medicaid for noncompliance. But by going this route it allows you to build up his PNA to do a bigger shopping trip or buy him a more costly item. Even pay on his preneed funeral policy. You just need to make sure that every month his bank statement is below 2k as his assets must be under 2k for Medicaid.

And should you find you’d like to move him to a different NH - as it’s closer to you or better staffed or whatever - it will be eons easier to do so as you control the copay needed to be paid to each the month of the move. I moved my mom from 1 NH to another within her first year, it can be done but is a bit of a ballet to do. Trying to get old NH to deactivate a direct payee / Representative payee situation is not at all easy as the old NH can be totally foot dragging with you.

I’ve found some NH are totally predatory with the PNA $. Like they charge for cable & phone and the monthly fee is Viola! magically the exact amount of the PNA! And you have to send a written opt out request to get it cancelled. Yeah sure and I have some waterfront land in Plaquemines Parish in Louisiana or at Discovery Bay in MS to sell to you... The whole charging the resident for inflated toiletries cost is predatory behavior. You know at both NHs my mom was at, for those residents who had family who were themselves limited financially, the Salvation Army came in regularly to provide for free personal care packs of lotion, shampoo, etc. that SA gets from big co like Proctor & Gambel and repack. There should be no need to take funds out of their PNA for this much less price gouge for toiletries imo.

Usually the bathing room will have liquid soap dispensers for bathing to begin with, so no real need for body wash or bath soap and has stacks of towels to be used as well for residents who don’t bring in linens. These costs are within thier overall room & board fee. Take a peek into the bathing room. At my mom’s 2nd NH had a labeled bin / shelf for each resident with their stuff in them.
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My mom’s nursing home provided all that was needed. Her personal money allowed by Medicaid paid for the hairdresser and clothing. We never did anything with getting other items or getting reimbursed.
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I believe that Medicaid pays for incontience supplies. I wonder if the person you were speaking to knows the difference between Medicare and Medicaid. Many, many people do not.

In any event, if your loved one is going into a Nursing Home and will be on Medicaid, read your contract carefully and ask specifically about this issue, i.e., what are legitimate expenses for the personal needs allowance?

Of course you have to supply receipts; this is your loved one's money and it cannot be disbursed to someone else without proof that the money is being spent for their care.
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I have never heard that a NH can change a resident separately for personal care items like depends, TP, and such! What a PITA that would be to deal with receipts and reimbursements. Ugh. We only pay for Moms cableTV and hairdresser with hers. Hopefully someone more familiar with Medicaid law will chime in. Maybe this is how smaller NH handle it?
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