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PHBPHB Asked March 2019

My mother lives in a wonderful AL but will run out of money in a few months. Nursing homes have over a yearlong waiting list. What can we do?

 We have visited and applied to many local nursing homes, but all have over a year waiting list. We should have anticipated this, but we didn't. Her medical needs are way beyond our capabilities, and in home care is more than she or we can manage. Medicaid at home assistance in our state is only a few hours a week. Unless she has an acute medical incident requiring a three day hospital stay, she cannot get into a nursing home before her money runs out. What can we do? We seem to have no options.

cetude Mar 2019
Considering all the lawsuits against nursing homes especially over falls, I am surprised any can stay opened at all. there is a nursing home somewhere..but it won't be local. If the NH is too far, it is not good for the person. You see, someone must visit very frequently, preferably daily and do a skin inspection. If the NH staff knows they are not being watched they will do less care and that's when the bed sores and other things happen.

I've been taking care of my mom with end-stage Alzheimer's for YEARS and it has taken enormous emotional, psychological, financial and physical toll on me. it's very hard and VERY stressful that I do not recommend this route for anybody. However, I love my mom dearly so I put up with anything she can dish out, and I care less about my own life and health and willing to sacrifice whatever it takes to keep her comfortable and going. Because when they are gone you will never see them again. I often get nightmares about this. I dream of my mom dying or turning into a skeleton in front of me and I wake up screaming.

I tell people put them in a nursing home if you can. Otherwise you will end up like me and every waking second is attending to a very old, confused, weak and sometimes combative person..and every second constantly on guard for her safety. It's very hard. It's a very heartbreaking..and backbreaking..experience.
Emart30 Mar 2019
Have you considered a caregiver support group?  I know people say that they do not have time. When?  if you are the primary caregiver do not make time, you will end up sick, depressed, and you will not be able to care for your loved ones.   PLEASE, remember to make time for YOU!
biscer611 Mar 2019
Sorry to hear your situation has deteriorated to this degree. I agree with you that you should have anticipated this but that’s water under the bridge now. The ALF should have advised you from your initial tour of their community what to expect and how to plan moving forward with her Financial and medical needs. At point of move in, this discussion should have expanded, with detailed information regarding your ability to pay and for how long clearly understood by all parties. Communication or the lack there of is what creates “crisis” moments like these, not the system. We need to work with what is currently set in place versus cursing an already overburdened system.

Contacting your local agencies on Aging is very important right now. If there is a discharge imminent from the ALF, reach out to your Ombudsman, Adult Protective Services etc. They can not carry out an unsafe discharge that puts the resident in harms way. This will prompt the ALF to go further to assist you and your needs.

Is the ALF your Mom is currently residing in a Medicaid approved community, after a private pay spend down? Do they have a sister community or a SNF that can assist. Press them, as there is nothing to lose. They are culpable in this situation. You should have foreseen this but they did not due their due diligence in assessing your ability to pay from the start.
Many SNF/ Skilled Nursing Facilities will take direct Medicaid or admittance after a spend down of 3-6 months private pay. The year wait seems excessive; is this a year for private pay or waitlist? If it’s a waitlist, then you need to call weekly to each SNF, since people on the list move into another facility, remain at home or pass away while waiting. It is only a guesstimate on their part and very fluid.

Going to the hospital is only a very short term fix. Getting a 3 midnight admission into the hospital to qualify for a Medicare event is not a given. Also, if admitted and discharged to a SNF; likelihood only a small fraction of the 100 days granted by Medicare is to be given. Medicare does not keep paying if certain medical metrics are not met.

Is there an a life insurance policy in place that has a value of $100k. The value in the policy has the potential to offset care costs. Companies will give a percentage of the policies payout value for needs like these. Something to explore.

Finding a live in might be your immediate answer. Look to your local churches and charitable organizations for potential candidates.

Good luck. Gods speed.
gdaughter Mar 2019
Would only add that you might want to connect with an elder law attorney that is certified...for help with the medicaid process and sorting things out.

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BarbBrooklyn Mar 2019
Have you consulted with an eldercare attorney?

Get her on every waiting list you can. Visit homes AFTER she's on the list.

Make sure you are casting a wide geographic range.

NYDaughterInLaw Mar 2019
Cast a wider net. Even a placement farther away sounds like a better solution than holding out for a closer placement that may not happen in time, anytime soon or not at all.

After a long and tedious search a friend of mine found a religious group that ran a little nursing home. There were only two dozen residents or so. They accepted Medicaid. The place was simple, clean, and the staff was friendly. She placed her older sister with them after the money from the sale of her sister's home was spent and she could no longer afford the "nice nursing home".

azilmedia Mar 2019
Does she have any condition that could qualify her for home hospice care. They are quite helpful and resourceful in helping caregivers.
SusanNeedsHelp Mar 2019
Home hospice is covered by medicare, but any care she will also need, is not. So home hospice comes in a few hours a day. You have to find and pay for care for other care she needs. Very expensive at at least $20 an hour
CaregiverL Mar 2019
Take her to hospital...tell them you are no longer capable of caring for her...your health is suffering because of it. Tell them you want her evaluated for physical therapy & / or you believe she has UTI. Speak to Social Worker & let them work on a SNF placement. They’ll find something to keep her there 3 days. Either that or get At home Nurse Assessment & you’ll probably have to pay about $100. With that paper, take it to SNF admissions. Her primary dr can order Nurse Assessment. Hugs 🤗
Tvb49854 Mar 2019
Unfortunately, hospitals are aware of this tactic and have no obligation to admit a patient solely for placement. The hospital will not be paid by Medicare, Medicaid, or private insurance if there is not an admittable diagnosis. It is better to talk to the social worker ahead of time and make arrangements.

I am in a similar situation with the exception that my mother was evicted from an assisted living because of aggressive behavior which the aides invoked. But that is a whole ‘nuther conversation.

In retrospect, I wish I would have used the $90,000 that I wasted on assisted living and bought a house and hired private duty aides to keep my mother safe for as long as possible. Now my mother is back living with my husband and me and not only is it placing a strain on my marriage, it is affecting our health.

I know it is too late for the original poster, but others need to be aware of what a scam the assisted living industry is. Choose placement carefully.
cetude Mar 2019
if she is hospitalized for three days (a doctor can diagnose her with failure to thrive or whatever) she can enter into inpatient rehab (nursing home) for 100 days which Medicare pays for. https://www.summitmedicalgroup.com/library/adult_health/sha_medicare_coverage_for_physical_rehabilitation/
Emart30 Mar 2019
Please note:  Some health insurance policies now waive the 3 day prior hospital admission if there is a skilled need a person can be directly admitted into a skilled nursing facility for a rehab stay.  While they are there under their skilled benefit, one can ask the facility to look for a long-term care bed.
annemculver Mar 2019
Your situation is heartbreaking, for you & your parent. It demonstrates the astounding lack of humanitarian resources in our so-called advanced nation. Make your circumstances known to as many potential resource options as you can. Advertise & inquire. What is your own housing? Can you possibly offer a live-in situation: offer room & perhaps some board to a person willing/able to help in exchange? I feel sorrow, as well as anger, for the terrible circumstances you have to navigate. I’m sorry we don’t do better as a nation - best of luck: I pray you find a solution.
Grandma1954 Mar 2019
some...not all may be due to people thinking that "Social Security" is all they need. Social Security is a Supplement NOT intended to be the sole income for retirement. People are living much longer then when "Social Security" was started.
So it is not all on the nation to provide for us in our retirement you have to save and prepare for your retirement.
Forget about saving money, the house, and "valuables" to pass on to your heirs this is what you use your assets for. No one wants the house, no one wants Grandma Betty's dresser...what they want is to not have to take you in because you can not live alone any longer or have to worry when you need extended care.
SusanNeedsHelp Mar 2019
Im curious. If you are running out of money on AL..how does one pay for Nursing Home? I have looked into this, for my father.for 'what if' situation, and I was going to have to put him into a Veteran's Nursing Home. What type of nursing home are you looking for? Medicaid covered? Nursing homes are much more expensive than AL
anonymous434963 Mar 2019
My understanding of PHBs dilemma is that her mom, who evidently would qualify for nursing home care because of her medical condition, is going to run out of money soon paying for AL. At that point, she would be eligible for Medicaid, but Medicaid won't pay for AL; Medicaid will only pay for nursing home care--except for some exceptions for home care, which evidently won't work for PHBs mother.
Between a rock and a hard place.
Biscer611 offers good advice, I think.
anonymous839718 Mar 2019
Lynn2019, I agree with you totally. A lot off Medicaid nursing home issues would be solved by people taking more responsilibility for their finances. Medicaid was not designed to be the nursing home solution for everyone. It was supposed to be for the truly poor.

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