Follow
Share

My 78 yr old mother-in-law was diagnosed a year ago with early stage Alzheimer's and that she requires 24x7 "custodial care" but not "skilled care". As a result my husband lost his job to assume his new job of full time "custodial care" for his mom. Her monthly income is slightly above the Medicaid limit even though her assets have been progressively spent down over the last 4 years to where she has less than $2K in assets. (she wasn't a rich woman to begin with and neither are we)


In the last few months, she has required A LOT of assistance where we can't get sufficient sleep and we now need to take care of all her toileting needs. She can still walk but falls more. At what point does she get classified as needing skilled care? what is the criteria for skilled care in order for us to get help financially for respite care or long term care? Sundowning issues are emotionally draining and since she can't keep still and needs help up and with everything, it is physically draining. Really could use some regular respite care but need funds to do it. (FYI-She sold her condo (not much profit) and came to live with us 4 years ago because she couldn't take care of herself let alone a condo.) What are some of the things an Alzheimer's patient need that would require "skilled care" to qualify for help? Thanks in advance.

This question has been closed for answers. Ask a New Question.
Wow, thank you all so much for the invaluable advice. It has given us new hope and new avenues to go investigate.

igloo572- no, not railroad. but thanks for the ton of suggestions regarding Miller trust and NH directors helping with charts.

-Sunnygirl - thank you so much for the special assistance tip

gladimhere - you so much for the tip regarding hospice when it get to that point and also for pointing out that it is considered a disability.

Thank you so much.
Helpful Answer (1)
Report

I brought up hospice, not because of her condition, but because some assisted living/memory care will permit hospice to come in when the time comes (thus avoiding the need for skilled nursing). It makes it easier on the patient to not have to move because of limited services available at the facility. It is something to be considered when choosing memory care.

Alzheimer's is considered a disability so she should qualify for services. The social worker at a facility would be able to assist with getting her qualified.
Helpful Answer (1)
Report

Satin - a thought just occurred to me.... Is mil railroad retiree? If so, please post that. RRRB is kinda quirky to deal with both medically & financially.
Helpful Answer (0)
Report

Satin - find a new MD for mom & look to see if mom can get a Miller done.

Here's my suggestion & experience as my mom was in a similar situation: my mom was in IL in a tiered facility (ran IL to AL to nH with hospice wing). She started having sundowning & medication management issues. The medical director insisted mom was good for AL (private pay) and not needing skilled NH (Medicaid). Would not budge on this and in addition staff made comments as to "that I wouldn't want my mom to be in one of those medicaid places with you know those kind of people". Mom was still seeing the doc's at her old gerontologist group & allmost all of them were medical directors at NHs. Long story short took about 5 mos of every 3 -5 week visits to gerontologist to establish health history to show need for skilled. The visit she had a 10% weight loss, bad H&H lab work and couple of other issues her doc wrote orders for skilled nursing needed. Mom moved into a NH where 1of the other gerontogsts from her group was the medical director & applied for Medicaid 5 weeks later.
MDs who are medical directors of NH know what needs to be in their chart to pass review to show the need for skilled. It can be something easily done like switch a RX from pill to one that needs to be compounded or go from Exelon pill to patch, both of these require more "skill". Go and find a couple of NH that take Medicaid and get your mil to be a patient of the medical director within their private practice & get her chart going to show the need for skilled. Your mil could be already there just needs a fresh interpretation by the new MD. Often family medicine & even internists - unless they deal day to day with NH medical review criteria - are clueless as to how charts are reviewed by medicaid.

About mil having too much income to qualify. Look to see if she can get a Miller Trust. Miller is a Qualified Income Trust. My mom had a super old insurance policy which paid a dividend annually. Moms income was over $ 1900 a mo (higher than most on medicaid) & the month paid took her over the income ceiling allowed for that month. What the caseworker did was have it amortized over the year so all within limits. So if your mil income is a variable like a dividend is, see if it could be amortized.

If its $ that gets paid each month like SS, retirement and their total just flat takes her over the income limit, see if her income sources can all fold into a miller trust. Say she gets 1k from SS, 1k from late hubs retirement and $ 800 from her own retirement. $2800 a mo. Your states Medicaid has income max of $2100. No matter what she is over $ 700 in income she cannot refuse but cannot qualify for Medicaid. She sets up a Miller to become the payee of all her income and then she gets paid $2100 with the $700 overage to the trust. Voila! She is good for medicaid financially! It will need to be set up totally legally & with flexability. Some states require an atty to do and others have a document that just gets filled out. Some states have it so all the $ goes to NH as her copay, while others have the excess actually go into a trust with the state as the beneficiary upon her death. Medicaid - although a federal & state joint program - is administered uniquely by each state. So just how miller runs totally dependent on your states laws & medicaid administration. Miller does require that the income source is "qualified" & most retirements are. Your hubs as her dpoa will need to get some sort of verification on this.

Miller isnt a secret. But the facilities dont mention them as its considered giving legal advice & they can't go there.... Plus Most in a NH are backside of 80 or in thier 90's and with income usually under medicaid income maximum. So needing to know about miller never comes into play. It's the more younger ones in thier 60's or 70's who have the higher income & can use a Miller like your mil. Once the tsumani of baby boomers start needing NH Medicaid lots of Millers are going to get done!

In theory the DPOA should be able to do all Medicaid financial stuff for their widow or widower parent. In reality if your doing day to day caregiving your too overwhelmed to get thorough imo. Gather together all her legal and income info. Especially find her "awards letters" - those are the notices sent like last Nov & Dec that state to the penny what her SS, retirements, etc. will be paying her starting Jan this year and go see an naela elder law atty on her behalf. It will be worth the cost. $200 to find & set into play the financial solution to get her moved out is kinda worth it.....
Helpful Answer (2)
Report

I'm going to send you a link by PM that you can check out. It has info on the state of Michigan.

I would explore if Michigan has a state funded Medicaid type benefit that pays for the long term care of those who are disabled and need assistance with daily activities, such as bathing, meals, taking medication, etc. Those with pronounced dementia are often unable to live without that assistance, so they can qualify if a doctor confirms they need that help.

In my state of NC, that Medicaid type plan is called Special Assistance and it pays for a person's long term care in an Assisted Living facility or Memory Care AL. They may not need skilled nursing, but they do need many other things or they could not survive. In NC the guidelines for qualification are similar to regular Medicaid LTC, with a few exceptions. The program is run by the same people who handle the regular Medicaid LTC. You can ask if Michigan has a similar type plan.
Helpful Answer (0)
Report

gladimhere thanks for your response but her dr. doesn't classify her as within 6 months from death to qualify for hospice and we are told by her dr and a memory care place that in order to qualify for Medicaid, she has to be classified as needing skilled nursing. Things like wiping her butt and assisting her dressing and such is considered custodial care, which is why I am asking the question, What determines "skilled nursing" care? Also, who pays for the lawyer if she doesn't have the funds and we can't afford one because lawyers generally run $200 an hour minimum here.?
Helpful Answer (0)
Report

Get the Medicaid application in process. Once she is on the program she will become eligible for many services. See an elder law attorney that specializes in Medicaid planning. Her income will not, by itself, disqualify her.

Start looking at memory care facilities that accept Medicaid and are a continuum of care so nursing is available when needed. Also, many memory care facilities will permit hospice care in order to keep them where they are familiar.
Helpful Answer (1)
Report

This question has been closed for answers. Ask a New Question.