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By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington. Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services. APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid. We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour. APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment. You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints. Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
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Mostly Independent
Your loved one may not require home care or assisted living services at this time. However, continue to monitor their condition for changes and consider occasional in-home care services for help as needed.
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70 year old with dementia lives in an assisted living facility, but money has run out. He did not qualify for Texas Medicaid due to a medication he takes for his symptoms. That does not sound right to me.
Bet that It’s not the meds per se, but rather that the meds he is prescribed fully enables him to go about his ADL / activities of daily living on his own, perhaps with a bit of occasional help. His care plan is not involved enought to warrant being “at need”.
You see this a lot in ESRD / end stage renal disease patients. They are medically just fine if they do their mutiple time a week dialysis & do proper diet. The issue often is they don’t have anyone to get them to/from dialysis or do an in home machine; they fail to stay in compliance with their dialysis schedule and ESRD diet. It’s a social problem not a medical problem. For those in this situation, if there is a PACE program in your area, it may work for him.
Based on my experience with TX Medicaid, the # of AL waivers is small as it’s hard to get facilities to participate as TX reimbursement day rate is low. AL can find private pay residents pretty easily so no need to bother with all the paperwork and regulations that being on waivers entails. Those with waivers tend to have an affliatedr adjacent NH and the AL waiver beds are placeholder beds waiting to move to the NH. For facilities this is a real efficient way to keep their beds full and coordinated care.
If there is anyway to get him into a SNF, imho that should be your goal. It may mean his health chart needs to be filled out more, see specialists, have more comorbidities, have a change in how he gets his meds from meds that he can self administer to ones that need skilled medication management. May mean he has to get a hospitalization and then discharge to a SNF for rehab and then he can hopefully qualify to remain as a custodial care resident.
Think outside of the box. Please pls realize the AL can evict him. So ya have to be proactive in all this.
In Texas, Medicaid eligibility is primarily determined by financial and medical necessity criteria, not by the specific medications an applicant is prescribed. However, certain medications may indirectly influence eligibility decisions, particularly if they suggest that the applicant does not meet the required level of care for specific Medicaid programs. Understanding Medicaid Eligibility in Texas To qualify for Medicaid in Texas, applicants must meet specific income and asset limits. Additionally, for programs like long-term care Medicaid, applicants must demonstrate a medical necessity for services, such as requiring assistance with daily activities or needing nursing facility care. Role of Medications in Eligibility Assessments While the medications themselves are not a direct criterion for eligibility, they can provide insights into an applicant's health status: Indication of Health Condition: Certain prescriptions may suggest that an applicant's condition is managed effectively, potentially leading assessors to conclude that the individual does not require the level of care provided by Medicaid-funded services. Assessment of Medical Necessity: If an applicant's medication regimen indicates stability and independence, it might impact the evaluation of their need for long-term care services. It's important to note that each case is unique, and decisions are based on a comprehensive assessment of the individual's health status, not solely on their medications. Appealing a Denial If an applicant believes they were wrongly denied Medicaid benefits due to misinterpretation of their medical needs: Request a Re-evaluation: Contact the Texas Health and Human Services Commission (HHSC) to discuss the decision and provide additional medical documentation if necessary. File an Appeal: Applicants have the right to appeal decisions. Detailed information on the appeals process can be found on the Texas Law Help website. Consult a Professional: Engaging with an elder law attorney or a Medicaid planning specialist can provide guidance tailored to the individual's situation. Source: ChatGPT search
I thought that AL was usually private pay, perhaps a couple of Medicaid beds, but you usually needed NH level care to qualify for Medicaid beds. Perhaps that’s wrong, but it ‘doesn’t sound right to you’. If you aren’t in control of this, you may not be being given the correct story.
You said "assisted living facility". In many states Medicaid does not cover Assisted Living. Per the search I did for Texas however, there are certain programs that will cover assisted living - in certain cases. So its not an all or nothing situation.
"Yes, in Texas, Medicaid can cover assisted living under certain conditions and through specific programs. While Medicaid generally doesn't cover the full cost of room and board in assisted living facilities, it can help with the cost of services like personal care, medication management, and onsite therapy. Texas uses Home and Community-Based Services (HCBS) waivers, such as the STAR+PLUS program, to provide coverage for assisted living."
I would call his caseworker and find out if the application was submitted to the appropriate programs to cover his care, and if those programs have limitations on anything like medication specifically?
That doesn't sound right to me, either. I can't know, and you seem not to know the full story here. Did you make the applications and receive the denial. I am afraid you may need some expert advice now on what exactly is happening here, and that would entail a POA, perhaps an Elder Law Consult.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
You see this a lot in ESRD / end stage renal disease patients. They are medically just fine if they do their mutiple time a week dialysis & do proper diet. The issue often is they don’t have anyone to get them to/from dialysis or do an in home machine; they fail to stay in compliance with their dialysis schedule and ESRD diet. It’s a social problem not a medical problem. For those in this situation, if there is a PACE program in your area, it may work for him.
Based on my experience with TX Medicaid, the # of AL waivers is small as it’s hard to get facilities to participate as TX reimbursement day rate is low. AL can find private pay residents pretty easily so no need to bother with all the paperwork and regulations that being on waivers entails. Those with waivers tend to have an affliatedr adjacent NH and the AL waiver beds are placeholder beds waiting to move to the NH. For facilities this is a real efficient way to keep their beds full and coordinated care.
If there is anyway to get him into a SNF, imho that should be your goal. It may mean his health chart needs to be filled out more, see specialists, have more comorbidities, have a change in how he gets his meds from meds that he can self administer to ones that need skilled medication management. May mean he has to get a hospitalization and then discharge to a SNF for rehab and then he can hopefully qualify to remain as a custodial care resident.
Think outside of the box. Please pls realize the AL can evict him. So ya have to be proactive in all this.
"Yes, in Texas, Medicaid can cover assisted living under certain conditions and through specific programs. While Medicaid generally doesn't cover the full cost of room and board in assisted living facilities, it can help with the cost of services like personal care, medication management, and onsite therapy. Texas uses Home and Community-Based Services (HCBS) waivers, such as the STAR+PLUS program, to provide coverage for assisted living."
I would call his caseworker and find out if the application was submitted to the appropriate programs to cover his care, and if those programs have limitations on anything like medication specifically?
I can't know, and you seem not to know the full story here.
Did you make the applications and receive the denial.
I am afraid you may need some expert advice now on what exactly is happening here, and that would entail a POA, perhaps an Elder Law Consult.