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lauren59 Asked July 2020

NYS Medicaid and Memory Care; How do people do it?

Dad 89, dementia, fell many times, in rehab. currently recovering from Hip facture/operation. He seems well cared for except that the dementia has gotten worse since in facility especially not being able to see loved ones.
Mom 86, home in their apt, my brothers and I see signs of dementia/ forgetfulness/confusion. She is very negative, sad, lonely, and in pain from arthritis. However, she was often like this even when Dad was home. She refuses to have help except from me and occasionly from my brothers.
I see on this site so often people speaking about assisted living and memory care but when I have looked into it, it is so very expensive in Westchester County, NEW YORK. How do people do it?
At this point I am working with a professional to get my Dad on Home Medicaid and than when he can return home, have 24/7 care for him.
Mom is beside herself because she doesn't want to "live" with a stranger in their one bedroom apartment.
I see no other way.
Please any insights that I am missing. This is very difficult on my own and has been for the past 5 years of caring for them, checking in on them, then helping to pack up their home of 52 years and moving them to a one bedroom apt, doctor appts, taking over all the mail and bills etc etc.... most people that haven't been through this just have no concept of the fact you are taking care of an entirely second household/healthcare.... etc.
Exhausting and does a number on your own life and health...

geddyupgo Jul 2020
So sorry for all the stress of your situation. Take small comfort that you are definitely not alone -- there are a lot of people on this ship.
First, understand the difference between the two main health insurances. Medicare is federally administered and is a health insurance. You qualify for Medicare by age and/or qualified disability. It will pay for 100 days of medically needed skilled nursing and/or rehabilitation after a 3 night stay at a hospital (day 1-20 full payment; day 21 -100 Medicare pays 80%, you pay 20%). It will NEVER pay for long term or custodial care. The payment period may be different if you have one of the many Medicare Advantage Plans that are heavily advertised these days.
Medicaid is administered by the state (so the qualification requirements and administration is slightly different in each state) and is the major payer for long term care (LTC) including custodial care. There are a number of Medicaid programs but the one that concerns you is the longer term care program; you must qualify for this medically and financially, as there are income and asset levels to be met. LTC and Assisted Living (AL) facilities are usually required to have a limited # of beds that are designated for Medicaid recipients (it's a formula based on the total number of beds but it is not a large number). Because Medicaid pays such a low daily rate, many facilities will not increase the #of Medicaid beds because they lose money (as with almost everything.... bottom line and return on investment come into play). Here's an example: Medicare caps it's payment for the first 20 days at an LTC at about $500 per day for rehab/skilled nursing. The average daily rate of a LTC in NJ about $300 per day. Depending on the facility, Medicaid might pay $240 per day so there's a daily loss. Now in NJ, (and probably most states) because ALs are not providing medically necessary care, only an "assist" with activities of daily living (ADLs), they generally are allowed to have a much lower # of beds allocated to Medicaid residents. So a 100 bed facility may only have to have 5 beds allocated for Medicaid patients. Generally, these beds are promised to people who are already in the AL and have been private pays. Many ALs will designate in their written contracts that a new applicant must be a private pay resident for 2 years to gain admission. If you can private pay for that amount of time, the trick is to make sure that you also get (in writing as part of the contract) the statement that your loved one is guaranteed a Medicaid bed in their facility when their private funds are depleted;this is important because they could be asked to leave if the previously designed Medicaid beds are occupied when they run out of private funds.
It can be a complicated and confusing area but try to get some info from the social worker at the facility your Dad is at now. Remember, he is not guaranteed 100 days only the number of days that he continues to make progress so get on this asap. Figure out how much funding you have available to take care of both of them. See if your local Medicaid office can supply you with a list of facilities that accept Medicaid - broaden your search area. Get on sites like A place for Mom, make sure they know your financial restrictions and see if they have any suggestions. I hope some of this helps. I'm not in NYS but if you have any more questions just message me. Will try to come up with more suggestions. One last thing - this search is going to be a long tough trip but you will get through as have millions of others..... you may need a glass of wine and some prayer but you will get through it. Good Luck!

MichaelEzekiel Jul 2020
The problem is they live in NYS. Out here in the midwest ALs and NHs are much cheaper, and often nice. If only....

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worriedinCali Jul 2020
NYS medicaid will pay for AL and memory care and there are facilities that are NOT private pay.
lauren59 Jul 2020
The 3 that I have been given are the bottom of the barrel places.  One in particular has Rehab and my Dad was in there last year and ended up getting worse and having to go back in the hospital with high fever and infection.
JoAnn29 Jul 2020
Independent living, Assisted Living and Memory care is private pay. If your grandparents have no assets or savings, they probably can't afford anything but LTC on Medicaid. I also suggest leaving Dad where he is on Medicaid. I would try to get more help for Mom.
lauren59 Jul 2020
I think after 100 days it is private pay and Medicaid no longer pays.

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