MIL on LTC Medicaid waiver & it’s paying for AL, amirite? & I’m guessing this is all brand new for you two & MIL.
If so, imo both you/hubs & AL need to take a step back as there are errors happening on both sides….. - AL cannot force MIL to make them representative payee for her SS. AL cannot force a $50 copay. But can require her account to end ea mo at zero & if need be can require financial responsibility contract done btw POA & them in order for her to stay there. Right now she’s owing $ not covered by Medicaid & makes AL concerned. That’s what the $50 is for, unusual but not unexpected. - AL needs to have an explicit & clear fee structure. If MIL not competent to understand, they need to review with hubs & you. - Why is MIL continuing a supplemental insurance policy? If she’s on custodial care Medicaid (aka LTC Medicaid) then Medicaid can & should become 2ndary health insurance. She needs to cancel or suspend old policy. If it’s an option to suspend it, try to have it suspended. Otherwise cancel. Adios that $98 a mo. - RX copays shouldn’t be happening as should be on whatever pharmacy system Medicaid uses. If it’s that an RX is not on Medicaid formulary, it needs to be switched over to one that is. If her doc writing script isn’t familiar with Medicaid in facilities, it may be the time to have her switch docs. If the AL has an affiliated MD or clinic that most residents use, that’s where I’d switch my LO too. - cell phone / landline. Well if need she can do without unless she absolutely needs 1 & can totally on her own be making all calls. AL should have a landline that residents can use…. Now it may be a phone set up in a seating adjacent to biz office. Personally at $35 a mo, I’d pay that for her but tell her it’s going to be phased out eventually. At some point, Mil is gonna be calling y’all dzs & dzs of times a day, starting early AM & that phone is adios… - the “car” & $800 yr ins + gas & maintenance. So 1K a yr. Here’s the rub on LTC Medicaid & their continuing to own car or home….. they r allowed to have home / car as exempt asset for lifetime & eligible for LTC Medicaid as long as they are otherwise “at need” financially & medically. Financially means IMPOVERISHED. & means they do a copay of all income less that $60 personal needs allowance (a PNA). So if elder wants to keep old house & car they can BUT have no-nada-zero $ to pay a penny on them. So family needs to pay & do whatever to enable their elder to continue to own house / car; it’s totally on family to pay & pay till beyond death. If family cannot afford or doesn’t want to, then either they get sold or go to rot or go up for tax sale. Yeah it’s harsh, but LTC Medicaid means impoverished. She can keep car but on you to pay. IMPT: Please realize that selling her car now will pose issues for her Medicaid eligibility as mo she sells it that $ is income that will take her over Medicaid max that mo & then becomes an asset that if it takes her over 2K in her bank account takes her over Medicaid asset max. She will become Medicaid ineligible. - incidental charges. MIL is doing things that have an a la carte charge. If grabbing snacks, or saying “I want XYZ shampoo”, she will be billed. A resident commissary is not free. Is she competent to understand this? - $50 on site beauty shoppe seems high. I’d ask to see the bill. She could have tipped $$$. - could Mil have given chocolates to staff?
Imo a lot of the issues y’all are having are related to not understanding how narrow LTC Medicaid coverage is, what it’s requirements are and how things need to change once LTC Medicaid done. & this not only for elder but also for POA & family if elder is going to continue to keep old car, old home as family will have to cover costs till beyond death & then deal with estate recovery (MERP) if need be.
If beyond what Medicaid pays, it’s on family to cover those costs. If not done, she’s out of compliance & AL can do a 30 Day Notice to move.
NO! THEY CANNOT!!! AL facilities, nursing homes, rehabs... pull this crap all the time with a POA. They want to make sure it all goes to them even what they are not owed. If you have POA tell whatever AL you're dealing with that you demand a written bill every month. After you get done scrutinizing it to make sure the dollar amount is actually owed, then pay it. They have zero legal right to charge $50 for any "needs" that were not authorized by whoever is the POA (or by the AL resident themeselves if they're still handling their own affairs). Also, when a person is on Medicaid there is no co-pay involved. Whatever AL you're dealing with is trying to shake you down. Don't allow this. Tell them plainly to go pound sand and stop threatening you with this shakedown. Let them know Medicaid doesn't have co-pays. Then insist on a written bill every month. Also, let them know that you will be speaking to the Ombudsman's Office as well as your state's Attorney General. Just for good measure.
Burnt, if Medicaid is paying for her stay, that room&board bill technically is an agreement between the facility and the State. And the “bill” probably will not at all look like a private pay invoice and may be actually for the facility for that month overall. It will not be simple to get the State/NH bill. The resident in my experience isn’t entitled to it.
A LTC Medicaid resident only gets from the NH the monthly statement that is whatever the State Medicaid program has determined is their required copay based on their monthly income (submitted in their Medicaid application) and a separate needs allowance bill. My moms first NH had beyond bad billing office; healthcare side was for the most part at the beginning just fine but administrative a nightmare. Every mo billing errors as they had copay wrong. I did speak with caseworker and he had me contact regional Medicaid office & they sent me their internal room&board payments which shows NH paid in real time and it was like a dzs+ pages; and then Medicaid regional resent the required mo income compliance Notice to both mom, me as POA and to the Administrator of the NH. Couple weeks later it all was corrected and reset to zero after maybe 7 months.
As long as the resident is paying $ amount as per their Medicaid eligibility letter and keeping the on site NH trust account with enough $ to cover incidentals, like beauty or barber shoppe, there should be no charges & no need to have the facility become the representative payee.
Problem is residents go and get things not covered. And in this case, the OP MIL is in AL so it’s an way more active and busy group. Likely most private pay and those residents do not have to ever think twice about buying stuff, ordering extras, going on field trips. But for an elder now finding themselves on Medicaid - so impoverished - they might not be understanding or accepting that they are poor. They cannot blithely just go on the shopping & lunch field trip with others from the AL as they have NO MONEY. Cannot blithely grab a candy bar on their way back from lunch. They can go on field trips, etc BUT need to have their family put extra $ into their PNA or give them $ or a CC so they can pay for things or they do not go on the field trip. If the $50 a mo, the AL is wanting paid is to be used as a payment resource to cover not paid by Medicaid costs, I think this is reasonable and it’s reasonable to have an small administrative fee to do this a well. MILHell & hubs need to review exactly what the charges are and if just going along with the $50 extra is flat the simplest way to deal with his moms spending.
They are right now paying at least $ 4,000 a yr to keep MIL to have her old lifestyle. If this isn’t sustainable from their own wallet, then they imo need to have a come to Jesus talk with MIL to have her realize that she is now poor, things need to change & she has only $60 to freely spend each month.
it isn’t easy and it isn’t at all pretty. But either you get it across to them that things need to change or you as POA / family just pay for whatever charges they rack up or costs on property they own. Sometimes it can make sense for the elder to keep their home and then family pay all costs on the empty home till beyond the grave and deal with whatever after death issues. But if it’s right now a conflict for them, it’s imo not sustainable for years and years.
I, highly recommend, that your husband contacts the police the next time he finds her soaking wet and untended. This is actually neglect and is elder abuse.
By law the facility has to provide a detailed list of charges. They can't just help themselves to her money or charge extra.
I would tell the stupid sob that is telling you no to a Zelle payment is actually telling you they won't accept a ACH payment. It's a no fee transfer that is the same as an autopay and that's what ACH is, it doesn't give them access to take her money, it's a clearing house.
I think they don't know what they are talking about and from everything you have shared, they are guilty of elder abuse and are now trying to set it up for financial abuse.
Everyone that visits and finds her uncared for and sitting in a dirty diaper needs to contact the police, every single time.
MILHell, the situation at the AL is not ever going to get better. They are clueless and incompetent. To me the overriding issue is that your MILs level of care - insulin by injection, pain medication, transition needed - is beyond what this AL can provide or is willing to provide and what is happening to MIL - RXs not being dispensed as per script, bodily fluids and fecal matter left on skin - is actually causing or will cause serious medical issues to happen. It is not a safe place for MIL.
im kinda wondering if all this obvious incompetence is being done deliberately….. that the AL has found themselves with a resident whose care needs are way way beyond what the staff at a AL can provide. That someone cocked up badly in allowing MIL to reside there. It appears They are doing stuff that makes it difficult to be in compliance for payment so can use that as a pretext to send you all a Notice to Move and then the horrid care situation is going to lead to a care crisis… like wound care needed from the crap show MiL sat in, or some sort of diabetic crisis. Most AL do not ever have the need to have lower rate paid room&board LTC Medicaid beds to run their place; there are plenty of folks who have the private pay funds to pay for AL care; AL don’t need to rely on finding impoverished residents who can be on Medicaid.
The only time I’ve seen an AL ever having LTC Medicaid beds that provided a more skilled level of care was at a facility that was tiered, so went from IL to AL to NH or AL to NH. The AL side had just a few LTC Medicaid beds and they all were basically placeholder beds till someone in a Medicaid bed on the NH side died and then that AL Medicaid resident moved over to the NH. There was continuity of care easily happening as Nh staff could come over and do things. Freestanding AL just are not staffed to be able to provide lots of hands on care; AL “assisting” is more about helping them in daily life activities, like zipping up back of a dress, assisting in transition in the shower, helping them in&out of the shopping trip van. LTC Medicaid pays a fixed low rate, if MiL needs loads of staff time - which it seems she does - she’s a drag on their staffing for other residents. Paying extra for medication management is kinda standard for an AL to charge. But dealing with a resident who need daily insulin and whatever else her diabetes management needs is imho beyond the wheelhouse for AL.
what would be simplest plan would be for there to be something that staff notices that seem to be such that a trip to the ER / ED is warranted and so EMS is called; MiL gets transported over to the ER at a hospital (not a UrgiClinic type of place but ER at a full fledged hospital); ER evaluates her and she gets admitted to the hospital; and then the AL refuses to take her back (they will say “we cannot meet the level of care for her); then the discharge planner at the hospital will then have to find her a place & it will be in a NH as Mil has serious diabetes needs plus whatever else will be in that now nice & fat chart from her ER and hospital stay; that Mil is already on LTC Medicaid will be a big plus for a Nh as they know the $ flow will not be an issue.
TIA aka transient ischemic attack is often used as a reason to call EMS. TIAs are really subjective as to how they present. It’s easy for an elder who is ill or with dementia to look odd enough to have had a TIA. & 99.9% of the time the EMS will load them up and take them to the ER.
ThIs AL is not going to get better and neither is the level of care your MIL needs. Try to get her out, into a hospitalization stay (Medicare pays) and then discharged for rehab (MediCARE pays) at a NH then she stays permanently at the NH (goes back onto LTC Medicaid). Really stay focused to get beyond this clusterF of a AL and get MIL into a Medicaid bed in a NH soon. Good luck.
igloo572 - you totally and accurately described the care level differences received between AL and LTC facilities. This is exactly what we encountered with our mother who initially was in AL independent level. I observed bare basics provided for cleaning apartment and residents got them self to the dining room 3 times daily. Those who used their medication dispense program paid extreme fees where they went to the nurse office to get their daily medications dispensed. Staff did NOT go to their room to give daily medications. There was no nurse staff in the building at night time either.
It was when our mother was admitted to ER and hospital for UTI infection followed by rehab - who confirmed she required much higher care level then provided in AL. The Rehab confirmed there was NO way she could return to her independent AL apartment with no one checking her multiple times per day, giving daily medications and meals, cleaning / dressing and getting her to toilet. No way could AL provide that level of care. Those care level requirements are the differences as to where the elder person needs to reside.
If your loved one is in an Assisted Living facility that is being paid for by Medicaid, then all of your loved one's income--social security, pension- is due to the facility as the resident's "share of cost". They are entitled to keep a small personal needs allowance each month.
Her income is owed to the facility and Medicaid pays the rest. The POA gets to decide whether or not they stay in control of a bank account and then pay the AL bill every month. The reason why they want that electronic deposit is so they can access what they may not be entitled to. They can pad a bill and then say monies are owed whrn they are not. They will also take the small money the resident is allowed to keep every month for personal items. Never allow any care facility access to a bank account.
How long does it take for the omnsbudsman to call you back?
My husband and I went out of town Friday evening. We were to come back tomorrow.
The assisted living would not allow the nurse we hired out of pocket to administer insulin shots twice a day to perform the duties. Administrator said liability concerns. We had to come back early. We found mother in law covered in urine, her walker on the other side of the room, and her help string out of her reach. No depend on.
Her chair is destroyed from the urine. The smell will not come out.
How sad she is not being taken care of. It really pulls on the heart strings doesn’t it. I would move her to a different facility. I hope you took pictures and file a complaint with the state. Find a facility that has Transportation or hire a ride for appointments. Get rid of the car.
Last night when husband went to do the insulin shot, mother in law told him there was an envelope for him.
On Thursday, she had an appointment and he asked that she get her shower before the appoimtment rather than after dinner that day. He was told it was not a problem by the aide.
The aide was fired because it was not approved by management and we now have a $75 bill.
&
I’m guessing this is all brand new for you two & MIL.
If so, imo both you/hubs & AL need to take a step back as there are errors happening on both sides…..
- AL cannot force MIL to make them representative payee for her SS.
AL cannot force a $50 copay. But can require her account to end ea mo at zero & if need be can require financial responsibility contract done btw POA & them in order for her to stay there. Right now she’s owing $ not covered by Medicaid & makes AL concerned. That’s what the $50 is for, unusual but not unexpected.
- AL needs to have an explicit & clear fee structure. If MIL not competent to understand, they need to review with hubs & you.
- Why is MIL continuing a supplemental insurance policy? If she’s on custodial care Medicaid (aka LTC Medicaid) then Medicaid can & should become 2ndary health insurance. She needs to cancel or suspend old policy. If it’s an option to suspend it, try to have it suspended. Otherwise cancel. Adios that $98 a mo.
- RX copays shouldn’t be happening as should be on whatever pharmacy system Medicaid uses. If it’s that an RX is not on Medicaid formulary, it needs to be switched over to one that is. If her doc writing script isn’t familiar with Medicaid in facilities, it may be the time to have her switch docs. If the AL has an affiliated MD or clinic that most residents use, that’s where I’d switch my LO too.
- cell phone / landline. Well if need she can do without unless she absolutely needs 1 & can totally on her own be making all calls. AL should have a landline that residents can use…. Now it may be a phone set up in a seating adjacent to biz office. Personally at $35 a mo, I’d pay that for her but tell her it’s going to be phased out eventually. At some point, Mil is gonna be calling y’all dzs & dzs of times a day, starting early AM & that phone is adios…
- the “car” & $800 yr ins + gas & maintenance. So 1K a yr.
Here’s the rub on LTC Medicaid & their continuing to own car or home….. they r allowed to have home / car as exempt asset for lifetime & eligible for LTC Medicaid as long as they are otherwise “at need” financially & medically. Financially means IMPOVERISHED. & means they do a copay of all income less that $60 personal needs allowance (a PNA). So if elder wants to keep old house & car they can BUT have no-nada-zero $ to pay a penny on them. So family needs to pay & do whatever to enable their elder to continue to own house / car; it’s totally on family to pay & pay till beyond death. If family cannot afford or doesn’t want to, then either they get sold or go to rot or go up for tax sale. Yeah it’s harsh, but LTC Medicaid means impoverished. She can keep car but on you to pay.
IMPT: Please realize that selling her car now will pose issues for her Medicaid eligibility as mo she sells it that $ is income that will take her over Medicaid max that mo & then becomes an asset that if it takes her over 2K in her bank account takes her over Medicaid asset max. She will become Medicaid ineligible.
- incidental charges. MIL is doing things that have an a la carte charge. If grabbing snacks, or saying “I want XYZ shampoo”, she will be billed. A resident commissary is not free. Is she competent to understand this?
- $50 on site beauty shoppe seems high. I’d ask to see the bill. She could have tipped $$$.
- could Mil have given chocolates to staff?
Imo a lot of the issues y’all are having are related to not understanding how narrow LTC Medicaid coverage is, what it’s requirements are and how things need to change once LTC Medicaid done. & this not only for elder but also for POA & family if elder is going to continue to keep old car, old home as family will have to cover costs till beyond death & then deal with estate recovery (MERP) if need be.
If beyond what Medicaid pays, it’s on family to cover those costs. If not done, she’s out of compliance & AL can do a 30 Day Notice to move.
If you have POA tell whatever AL you're dealing with that you demand a written bill every month. After you get done scrutinizing it to make sure the dollar amount is actually owed, then pay it.
They have zero legal right to charge $50 for any "needs" that were not authorized by whoever is the POA (or by the AL resident themeselves if they're still handling their own affairs).
Also, when a person is on Medicaid there is no co-pay involved.
Whatever AL you're dealing with is trying to shake you down.
Don't allow this. Tell them plainly to go pound sand and stop threatening you with this shakedown. Let them know Medicaid doesn't have co-pays. Then insist on a written bill every month. Also, let them know that you will be speaking to the Ombudsman's Office as well as your state's Attorney General. Just for good measure.
A LTC Medicaid resident only gets from the NH the monthly statement that is whatever the State Medicaid program has determined is their required copay based on their monthly income (submitted in their Medicaid application) and a separate needs allowance bill. My moms first NH had beyond bad billing office; healthcare side was for the most part at the beginning just fine but administrative a nightmare. Every mo billing errors as they had copay wrong. I did speak with caseworker and he had me contact regional Medicaid office & they sent me their internal room&board payments which shows NH paid in real time and it was like a dzs+ pages; and then Medicaid regional resent the required mo income compliance Notice to both mom, me as POA and to the Administrator of the NH. Couple weeks later it all was corrected and reset to zero after maybe 7 months.
As long as the resident is paying $ amount as per their Medicaid eligibility letter and keeping the on site NH trust account with enough $ to cover incidentals, like beauty or barber shoppe, there should be no charges & no need to have the facility become the representative payee.
Problem is residents go and get things not covered. And in this case, the OP MIL is in AL so it’s an way more active and busy group. Likely most private pay and those residents do not have to ever think twice about buying stuff, ordering extras, going on field trips. But for an elder now finding themselves on Medicaid - so impoverished - they might not be understanding or accepting that they are poor. They cannot blithely just go on the shopping & lunch field trip with others from the AL as they have NO MONEY. Cannot blithely grab a candy bar on their way back from lunch. They can go on field trips, etc BUT need to have their family put extra $ into their PNA or give them $ or a CC so they can pay for things or they do not go on the field trip.
If the $50 a mo, the AL is wanting paid is to be used as a payment resource to cover not paid by Medicaid costs, I think this is reasonable and it’s reasonable to have an small administrative fee to do this a well. MILHell & hubs need to review exactly what the charges are and if just going along with the $50 extra is flat the simplest way to deal with his moms spending.
They are right now paying at least $ 4,000 a yr to keep MIL to have her old lifestyle. If this isn’t sustainable from their own wallet, then they imo need to have a come to Jesus talk with MIL to have her realize that she is now poor, things need to change & she has only $60 to freely spend each month.
it isn’t easy and it isn’t at all pretty. But either you get it across to them that things need to change or you as POA / family just pay for whatever charges they rack up or costs on property they own. Sometimes it can make sense for the elder to keep their home and then family pay all costs on the empty home till beyond the grave and deal with whatever after death issues. But if it’s right now a conflict for them, it’s imo not sustainable for years and years.
In my state, there is an 800# you can call to find out who the ombudsman is.
You need to complain about the check processing fee, the missing items and the medication mis-management.
Information about the ombudsman should be posted in the lobby of the facility.
I, highly recommend, that your husband contacts the police the next time he finds her soaking wet and untended. This is actually neglect and is elder abuse.
By law the facility has to provide a detailed list of charges. They can't just help themselves to her money or charge extra.
I would tell the stupid sob that is telling you no to a Zelle payment is actually telling you they won't accept a ACH payment. It's a no fee transfer that is the same as an autopay and that's what ACH is, it doesn't give them access to take her money, it's a clearing house.
I think they don't know what they are talking about and from everything you have shared, they are guilty of elder abuse and are now trying to set it up for financial abuse.
Everyone that visits and finds her uncared for and sitting in a dirty diaper needs to contact the police, every single time.
They are clueless and incompetent.
To me the overriding issue is that your MILs level of care - insulin by injection, pain medication, transition needed - is beyond what this AL can provide or is willing to provide and what is happening to MIL - RXs not being dispensed as per script, bodily fluids and fecal matter left on skin - is actually causing or will cause serious medical issues to happen. It is not a safe place for MIL.
im kinda wondering if all this obvious incompetence is being done deliberately….. that the AL has found themselves with a resident whose care needs are way way beyond what the staff at a AL can provide. That someone cocked up badly in allowing MIL to reside there. It appears They are doing stuff that makes it difficult to be in compliance for payment so can use that as a pretext to send you all a Notice to Move and then the horrid care situation is going to lead to a care crisis… like wound care needed from the crap show MiL sat in, or some sort of diabetic crisis. Most AL do not ever have the need to have lower rate paid room&board LTC Medicaid beds to run their place; there are plenty of folks who have the private pay funds to pay for AL care; AL don’t need to rely on finding impoverished residents who can be on Medicaid.
The only time I’ve seen an AL ever having LTC Medicaid beds that provided a more skilled level of care was at a facility that was tiered, so went from IL to AL to NH or AL to NH. The AL side had just a few LTC Medicaid beds and they all were basically placeholder beds till someone in a Medicaid bed on the NH side died and then that AL Medicaid resident moved over to the NH. There was continuity of care easily happening as Nh staff could come over and do things. Freestanding AL just are not staffed to be able to provide lots of hands on care; AL “assisting” is more about helping them in daily life activities, like zipping up back of a dress, assisting in transition in the shower, helping them in&out of the shopping trip van. LTC Medicaid pays a fixed low rate, if MiL needs loads of staff time - which it seems she does - she’s a drag on their staffing for other residents. Paying extra for medication management is kinda standard for an AL to charge. But dealing with a resident who need daily insulin and whatever else her diabetes management needs is imho beyond the wheelhouse for AL.
what would be simplest plan would be for there to be something that staff notices that seem to be such that a trip to the ER / ED is warranted and so EMS is called; MiL gets transported over to the ER at a hospital (not a UrgiClinic type of place but ER at a full fledged hospital); ER evaluates her and she gets admitted to the hospital; and then the AL refuses to take her back (they will say “we cannot meet the level of care for her); then the discharge planner at the hospital will then have to find her a place & it will be in a NH as Mil has serious diabetes needs plus whatever else will be in that now nice & fat chart from her ER and hospital stay; that Mil is already on LTC Medicaid will be a big plus for a Nh as they know the $ flow will not be an issue.
TIA aka transient ischemic attack is often used as a reason to call EMS. TIAs are really subjective as to how they present. It’s easy for an elder who is ill or with dementia to look odd enough to have had a TIA. & 99.9% of the time the EMS will load them up and take them to the ER.
ThIs AL is not going to get better and neither is the level of care your MIL needs. Try to get her out, into a hospitalization stay (Medicare pays) and then discharged for rehab (MediCARE pays) at a NH then she stays permanently at the NH (goes back onto LTC Medicaid). Really stay focused to get beyond this clusterF of a AL and get MIL into a Medicaid bed in a NH soon. Good luck.
It was when our mother was admitted to ER and hospital for UTI infection followed by rehab - who confirmed she required much higher care level then provided in AL. The Rehab confirmed there was NO way she could return to her independent AL apartment with no one checking her multiple times per day, giving daily medications and meals, cleaning / dressing and getting her to toilet. No way could AL provide that level of care. Those care level requirements are the differences as to where the elder person needs to reside.
Can you clarify what your question is?
They are charging you 50.00 for your loved ones Medicaid copay?
Are you power of attorney for the resident?
The POA gets to decide whether or not they stay in control of a bank account and then pay the AL bill every month.
The reason why they want that electronic deposit is so they can access what they may not be entitled to. They can pad a bill and then say monies are owed whrn they are not.
They will also take the small money the resident is allowed to keep every month for personal items.
Never allow any care facility access to a bank account.
My husband and I went out of town Friday evening. We were to come back tomorrow.
The assisted living would not allow the nurse we hired out of pocket to administer insulin shots twice a day to perform the duties. Administrator said liability concerns. We had to come back early. We found mother in law covered in urine, her walker on the other side of the room, and her help string out of her reach. No depend on.
Her chair is destroyed from the urine. The smell will not come out.
On Thursday, she had an appointment and he asked that she get her shower before the appoimtment rather than after dinner that day. He was told it was not a problem by the aide.
The aide was fired because it was not approved by management and we now have a $75 bill.
My husband is furious. This does not seem right.
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