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Cousin is in rehab (falls, hosptial, rehab, home... cycle), her Doctor faxed a letter to the Rehab Center stating she needs 24 hour care. Does this mean she can't go home without 24 hour care? She lives alone, and can't afford 24 hour care. She is resistant about assisted living (I've tried). Is there an insurance ramification if she goes against this doctor letter?

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I would say the letter was written in case she needed to be put in LTC. At this point, she needs an AL.
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Spoke to Social Worker at rehab facility.. the doctor's note is just to say that she needs the 24 hour care.. if she goes home without it, it will not affect her insurance or Medicaid. I can already see the future.. she WILL go home and she WILL fall within the first week...Trying my best to get her to stay at AL for three months during the winter...
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tacy022 Nov 7, 2019
All social workers have different priorities.

We were threatened with abuse charges from the Medicaid SW if we did not provide the 24/7 care in accordance with the same letter. You should speak to an attorney regarding whether or not you have accountability if POA is in effect and 24/7 care is not provided.
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I have heard that if someone is on medicaid, that you can get them to cover help from the company, home instead. If no medicaid, then go to your aging and disability resource center: At mine, They will provide free light house keeping for disabled and low income elderly, along with a handyman service that is free, as well (You must provide the supplies for the handyman to do the job you want).

But the con parts are that these are not 24 hour services, they put in a 12-13 hour day and then go home or just do a few things and then go home. So maybe looking into assisted living or a nursing facility would be a good idea. It could be permanent or temporary, it depends on the situation.

Good luck and best wishes to you and your cousin.
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How is her mental status? Does she have the capability to make these important decisions about where she wants to live?

Everybody WANTS to stay in their own home. That doesn't mean that it's a good idea when they are no longer safe on their own.

I think you should follow the doctor's letter. To me it means she needs to be in a facility. Ask the place she is in now to help you with that. I would look into a nursing home, if it were me.

Good luck.
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Serenamcn18 Nov 7, 2019
her mental status is so-so. She has short term memory problems. But I don't believe I can force her to AL. I have a call into the head of the Rehab facility to get his take on what the letter means. She is determined to go home. I don't know how she is getting there, as she doesn't drive and no one will take her.. *sigh*
She wants to go to "respite care" for 2 weeks.. this is at the assisted living facility that we all want her to go to permanently . But she wants a landline phone installed. I did this a few months ago and it was a huge hassle. Then she only stayed for 3 weeks and we had to return all of the equipment. I'm going to tell her no landline for 2 week stay.. only if she commits to 3 months or more...
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So, just to be sure.. if she goes home against the Doctor's letter, then it won't impact her insurance? She will definitely have another fall...
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Serenamcn, the doctor feels your Cousin can no longer be left alone being she is a major fall risk.

If your Cousin cannot budget for home caregivers, then have her apply for Medicaid [which is different from Medicare]. Each State has their own programs. I know you mentioned that your Cousin is resistant about going to a nursing home, but there does come a time when she no longer has a choice. Medicaid will pay for her room/board and care in a nursing home.

Otherwise, you will need to do what many of us here had to do. Wait for a major emergency to happen... thus 911, rehab, nursing home.

My Mom refused 24 hour care, she claimed my Dad could take of her. Both she and my Dad were in their 90's living in their home. It didn't hurt her Medicare insurance when she had another serious fall, which put her into long-term-care as she had a brain injury and could no longer walk.... [sigh]. But Dad had to pay out-of-pocket for the facility.
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