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boombop Asked June 2019

What are the living conditions of Medicaid SNFs? What is the quality of the care like?

My mom has schizophrenia and fairly young. In her early 60s. She's lucky enough to have a trust and money to support her for a few years but will eventually have to go on Medicaid once it runs out.


This has been keeping me up at night because I've heard Medicaid SNFs are terrible - described as the worst living conditions one could be in.


Is this the case? Will she be living an okay life being fully cognitive in that kind of environment? I'm presuming she may be there for many years. Are there some that are nicer than others?


Any honest answers or experiences are helpful.

JoAnn29 Jun 2019
Most LTC is private pay with a number of beds set aside for Medicaid recipients. As such, the Medicaid recipients are treated no different than the private pay. Actually, the staff should not be informed about who is PP and who is Medicaid. I will say though, that my Mom was taken from a 2 person rm when she was PP to a 4 person room when she started Medicaid. By that time though, she had no idea where she was and staff kept her in the Common area where the activity was. She only slept in the room.

BarbBrooklyn Jun 2019
About how to find places, there is a tab on this site--Find Care and Housing. You type in your zip code or city and you get a long list of places.

I think you want to start out looking at geographically convenient places and visit them. Cast your net farther if you don't find anything that suits close by.

You might consider not mentioning her schizophrenia upfront; let them read a detailed report from her treating psychiatrist after you've made a visit.

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Treeartist Jun 2019
Good morning, Boombop,

I see by your profile that you are caring for your mother living at home. Does that mean she is living at home independently and you are taking care of her, or that you are living together? Just wanted to get a clearer picture. Beside your mother’s schizophrenia, does she have any other physical limitations?

I don’t know where you live, but I can’t imagine where you heard that Medicaid SNF’s are “the worst living conditions one could be in”! That would keep me up at night too, if I thought that. I’m so glad that you reached out to us here to get some truth. I can’t speak for all states, but here in one of the poorest states in the Union, SNFs don’t separate into Medicaid or self-pay facilities - they are a mixture of both, and as someone has already stated, the staff doesn’t discriminate in their care. Besides the fact that to do so would be illegal and unethical, they just don’t know who is on Medicaid or is self-pay! Only the business office knows.
Some of these facilities are run better than others, but there is a lot of state oversight,

My parents are both in a SNF. It is not home, but it is clean, and cheerfully decorated, and has two full-time activities directors to keep the residents occupied if they so choose. Every day there is some volunteer group who comes in to entertain or just interact with the patients. The food is good, and they try to accommodate the residents’ food preferences from time to time (my father’s craving for fried okra).

Since your mother has some funds, she may be able to go to an Assisted Living facility first, which is generally self-pay.
You may want to find a Continuing Care facility that provides different levels of care, from independent living to skilled nursing.

My mother was diagnosed with bipolar disease (formerly called manic-depression) over 6O years ago, and was in and out of psychiatric hospitals for decades. It is only in the last 16-17 years when first we, her children, and now, the facility, took charge of her medication, that her mental health stabilized. Her worst psychiatric episodes in recent years occurred due to UTI’s which are common in the elderly.

I think the main question is how stable is your mother when her mental illness is controlled, and what other disabilities does she have. Sorry this post is so long, but I have been where you are, worrying about a parent - everyone on this forum has been there. There is so much misinformation out there. I hope we have helped you to get a good night’s sleep!
boombop Jun 2019
No, this is incredibly helpful. Thank you. She's in a very good position as her illness is stable. She was living at her home with a companion - but we just recently moved her into an assisted living facility. Where she also has a private companion. My main concern is that moving her into an assisted facility, as nice as it is, was a huge lifestyle adjustment. A lot compared to how she was living before.

I have very minor experiences with SNF but i just remember one my dad went to after a surgery - it was a nightmare, very drab and outdated looking. People screaming, loud noises, poor response time etc...

She's doesn't have any issues outside of her mental illness. She just had knee surgery but has recovered very well. She can walk on her own, dress, bath, etc... so physically independent in that sense. She just needs medication management.

We're located in Southern California - we have family in San Diego and I'm in LA so she would mostly likely be situated in either place.
Ahmijoy Jun 2019
Some posters on this site generalize all facilities as evil and dirty with abusive, uncaring staff who neglect their residents. Unfortunately, facilities like this are the ones who make the news. But...

You need to tour the facilities where you are interested in placing your loved one. This is a totally personal decision. Even the most beautiful facility may not be the right fit for your loved one’s needs.

My mom was in a Medicaid facility. It was a wonderful place. It was clean and bright and the staff was kind and caring. It wasn’t one of the “resort” style facilities but she needed kind and caring staff and not a gourmet dining room with a chef and a bar or a boutique clothing shop. When she transferred to the Alzheimer’s unit, the staff there was kind to her as well, worrying about her stubborn penchant for taking off without her walker.

Do your homework and visit the facility personally. This is truly the best way to make this decision.

BarbBrooklyn Jun 2019
Many nursing homes that accept Medicaid also have private pay patients. Staff does not know who is paying what and there is no difference in the care.

You really need to go and look at facilities for yourself. Your mom is lucky to have you for her advocate!

gladimhere Jun 2019
You need to go and look at them. Check reviews online.
https://www.medicare.gov/nursinghomecompare/search.html?
https://www.google.com/url?sa=t&source=web&rct=j&url=https://health.usnews.com/best-nursing-homes&ved=2ahUKEwjWsuHLz4bjAhVZZM0KHR-MBW0QFjAOegQIBBAB&usg=AOvVaw2BNnBB_lUoPrtK6sMNEAM_

Many of them do not have the resort/hotel feel to them, but the care is excellent. There is one in my area, probably more, that is a continuum of care facility owned by a religious organization. It actually looks nice. The care is excellent. The drawback is that there is a two plus year waiting list.

There are independent living apartments, assisted living apartments, memory care and a nursing home. If you plan soon enough an apartment can be obtained, then the spend down is all accomplished while living in the same facility so relatively easy to receive increased level of care when needed.

Or get recommendations from a geriatric care manager. They have the inside scoop. Start. Your shopping soon.

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