My sister is in Assisted Living, but she falls several times a week. I found out they do not accept Medicaid. What would be the next step?

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Her illness is degenerative and she will not get better, so 100 days in a place would not be enough. She has Medicare and SCAN insurance. Her total income is $3000.

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She might look into a board and care situation. They usually only have about 5 or 6 clients and it is in a private home. There are caregivers there 24/7 and they also provide meals. It is not a very stimulating environment but usually costs less than an assisted living and they do provide meals and safety features such as bathing and dressing and help with the medications.
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A quick move to a facility that does accept Medicaid. You could be looking at anything from $200 to $300 a DAY for a non-supported pl;ace.
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Call your local Department of Health and/or Aging and Disability Center. Also try a local Senior Center. Ask for information regarding medicaid.

There might be programs in your area for assisted living such as a waiver program. Otherwise, you will need to look at nursing homes for medicaid options.

Take care.
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Typically Assisted Living is not a Medicaid 'function'.
There are unknowns here such as assets & property.....
If so; had prior planning to protect them taken place. Or are they part of the private pay spend down....

Are there enough assets available from somewhere to pay a private pay NH for about 3 months, {that will also accept MEDICAID} so you have a choice, (if she meets the health criteria for Medicaid)
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If your sister is falling several times per week, her needs are beyond what assisted living can provide. She needs to go to a long term care facility where is staff to help her so she won't fall. The last thing you want is for her to fall & fracture a hip or arm. Long term care facilities will get her on Medicaid if she has no assets. Is $3,000 her monthly income or annual income? Look for a long term care facility that will help you get her on Medicaid & work out the financials. She needs more supervision & help than what she gets in assisted living.
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In more remote areas they will sometimes take the majority of your sisters income to care for her in assisted living or a private personal care home. You will need the 100 days that Medicare approves to find a suitable place for her, call your area on aging for support but this type of placement usually requires a lot of phone calls to secure this type of placement and they often have waiting lists. If you are kind and communicative and your sisters disposition is pleasant people in this type of place will sometime push you through on the wait list.
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My understanding that Assisted Living has a lesser amount of direct care than a Nursing Home placement. It ha taken me awhile to realize the difference. It sounds like now she needs a Nursing Hoe placemen. I would think the facility she is in would help you find an appropriate placement. Usually there is a Social Worker to help with that. I am learning the ropes myself. I hope you can get some good help with this. chris
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My only experience with Assisted Living was with my sister who had MS. Once she could no longer stand by herself or get into and out of bed by herself she was out of there and had to go to a nursing home. They have their liability limits. I don't know about falling, but I would imagine that the Assisted Living facility is not a good place for her. Look for a long term care facility, one who has a nursing home attachment so as her condition deteriorates they can work her through the proper treatment channels in house. Many do accept Medicaid but there might be a waiting period so move quickly.
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I would begin looking for a new placement. It is rough to find a good NH which does take Medicaid. Second, if she is in a rehab assisted living under Medicare which can be given up to 90 or 100 days, however from experience these facilities seem to get more funds for the first 30 days and therefore they are determined to get the elder home after the first month to 6 weeks and get a new person in the bed who is in their first 30 days---it is a business to them.

I am concerned that your sister is falling. Given her condition you would think she would be "assisted" for transfers or walking times. If she isn't being assisted then why is she in assisted living.

Good luck.
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I'm assuming that precautions (such as removing rugs, adding grab bars), etc. have been taken but that the course of the illness indicates these actions won't provide the type of security she needs.

I'm not familiar with SCAN insurance. There are people here who are very knowledgeable on Medicaid issues though and I'm sure they will suggest that you attempt to qualify her for that. It seems that would in fact be the next step.

I don't know whether the social worker(s) at her current facility would be willing to help, but you could also contact your county goverment and ask if there are social workers there who can help with your application.

In the meantime, I would begin searching for a facility that will accept Medicaid, list the criteria for a placement and begin interviewing the ones that are candidates. Be sure to go around dinnertime to see what support patients are given before and after. Sometimes if the aide level is insuffucient, patients are left in need of toileting assistance because the staffing ratios are insatisfactory.

Medicare also has a section in which various facilities can be reivewed, infractions noted, and you can compare them. I found that helpful but nothing replaces an onsite inspection.

This might be a long shot, but you might contact one of the charitable organizations focusing on the illness your sister has and ask if they have a list of facilities that specialize in care of people with this illness.

I'm sorry for your sister's situation and hope you're able to find a placement that provides physical and emotional assistance to help her.
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