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anonymous181845 Asked August 2013

What do you do when insurance doesn't help? My family is overwhelmed.

I am new to this blog my best friend gave me this website to go to probably because she got tired of me complaining to her (lol). I picked this thread because of the heading it so fits my mother. Let me give you a little background my father had a massive stroke in 2011...my parents were married for 47 years and my mother had nothing outside of my father....so daily depression led into a stroke then dementia. My sister doesn't work so she was our only option to take care of mother since the rest of us cannot afford to work. I am the youngest and have been dealing with the insurance companies...who have advised me that there is no help from her policy since she has no option for long term care(blue cross and medicare)...advised us we can pay $20 an hour to have a caregiver in the home.....but who can afford that...she hasn't showered in over 5 months...yes you heard me right...everytime we try she gets physical and verbal...she is being abusive to my sister all day every day...embarrasses her in public...by yelling at her constantly.....throws stuff at her..me and my brother take turns watching her on weekends and she is nasty to us too..but not to the extent she is with my sister.....and its getting worse and my sister has told us we better think of what to do with mother because she cannot take it anymore (and I can understand)...nursing home is the only option..because although she has paid into her policy for well over 50 years...they say sorry can't help....and that's whats so frustrating...because we don't want our mother to go in there...we just know it is going to send her to an early death and her depression will get worse because she is a serious introvert....she doesn't really like socializing with people....my dad was her only friend..he couldn't even walk next door to my brother's house without her getting upset and calling him to come back home after like maybe an hour over there....As siblings we have been so sweet to each other our whole life...never really got into any arguments...but I am afraid that is going to change if we don't do something soon...but the frustration comes in as WHAT DO WE DO?

vstefans Aug 2013
londa, that's not usually how it works - the NH does not "take the home" strictly speaking, you may have to sell to pay bills if there is no other resource. Medicaid allows for the home to be exempted as an asset as long as there is stated intention of returning to it BUT there is "estate recovery" after the person passes on. You probably need to get in touch with local social services such as Area Agency on Aging or its equivalent and consider getting an estate planner. This was unknown turf to most all of us until we had to set foot on it...

anonymous181845 Aug 2013
Thanks..that helps a lot..this is some more background information...

My mother is still at her home and my sister stays there during the week...She is still making payments on her home and has over 30 acres of land..so we don't know if we should sell her home and use that money to pay $20 an hour for someone to stay with her....but my sister is worried that if we choose nursing home..that they will take her home and land and what if she only lives another 6 months...then the nursing home made out like bandits...now they have a home and land and we don't end up with anything and they only had to take care of her for 6 months.

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virtualhorizon Aug 2013
Hi londa01...As you've discovered, regular health insurance doesn't pay for long term care, whether it be Blue Cross or Medicare or any other private health insurance. Your Mom would have to have some type of long term care insurance to pay for a nursing home, etc., and I believe the average that they pay is around two to three years anyway. This is something so many people are running into now, especially in the case of Alzheimer's and other types of dementia. Lots of people, especially older ones, think that if they get an illness that requires long term care their insurance will cover it. Many people, like your family, find out the hard way that this just isn't the case. Its especially sad in the case of dementia, as it is an incurable, terminal disease. The patient doesn't get better, as might be the case with other diseases. Medicaid would pay if your Mom has next to nothing as far as assets go. If she does have assets, they'd have to be paid down and other rules would come into play. Unfortunately, if a person is rich he doesn't have to worry about paying because he has the money to do so; if a person is poor, Medicaid and the government will pay. But if you're a middle class individual who has done the right thing and saved over the years for your old age, you have to pay yourself into the poorhouse before anyone steps in.

If your Mom is totally out of it and abusive and unwilling to do anything, it might be possible to have her committed to a state hospital for observation. Medicare might pay for that if a doctor commits her. If she's taking meds they may need to be changed; often medications will cause chaos with people's minds.

I completely understand why you don't want your Mom in a nursing home. My Mom and I have been discussing for months the fact that we need to visit some places before the time comes that my Dad gets to the end stages. He was in very bad shape due to a medication change a few weeks ago and we thought we were going to have to do so right away. We visited a nursing home where a friend works -- supposed to be one of the best in town -- and upon leaving my Mom told me she would never put my Dad in a nursing home after seeing inside this one. It was clean, yes, but it was so sad looking at the people who didn't know what was going on, who were without family, etc. It was so clinical and depressing. Luckily after stopping the new med and going back to the old one, he got back to the state he was in prior to the change.

Good luck with your Mom. Please let us know how things are going.

If your Mom does need nursing/medical care, I believe Medicare will pay for in-home care in that respect. It would have to be prescribed by a doctor, though. You might check into this. I believe Medicare will only pay for a limited number of hours per week, but its worth a shot to check into it. They don't pay for sitting with people, helping them use the toilet, etc., just if there is a medical need for someone to be there.

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