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My mom is 92, currently in rehab at NH after an initial fall & then found she needed a pacemaker. She had a rough 12 days in hospital with lack of sleep & "sundowning" complete with hallucinations. She's been in rehab 25 days & she's doing very well with the physical therapy part but needs cues & help with daily living skills. She definitely is showing the dementia, often thinks she's at home & asks us to get things in kitchen,etc. We know she needs to be in long term but can only afford with Medicaid. I just turned in application 2 days ago, afraid they will want to discharge. She qualifies financially with SS of $1538. She owns a home, assessed at $184,000 but has had a reverse mortgage with line of credit & has used $131,000. I don't know how that will affect the Medicaid. I've looked at her files from NH as we were on our way to doctors. 2nd thing listed is Alzheimers/dementia so is this enough to keep her and move her to long-term? Thank you.

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Bellastar has a great point. On occasion, when the bank takes back the house, there is a positive cash addition to the elder's bank account. However, since your mom's house is in debt for more than half it's fmv, you won't have that problem.

A reminder: everyone, don't engage with people who argue. They don't need encouraging! Smile.
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cindyann - In regards to the reverse mortgage, I came across an article the other day when my mom was considering one. I found it here on Aging Care. I read in another post that links can't be shared. So the content of that article is below. So make sure to look into the profit that she might receive. It could bounce her out of Medicaid, but she'd have to take that cash and pay the nursing home privately. Once she spends it down, she would be eligible for Medicaid again. This is all based on how a person is eligible in Georgia. But here's the article...

With a reverse mortgage, however, you receive a check each month from the bank or mortgage company, and you never have to pay them back as long as you live in the house. If the loan is made to a married couple, then no repayment need be made until neither spouse is living in the home.

At that time, the loan is repaid, plus interest. If the family members cannot pay the loan off, the house will be sold. Note, however, that if the amount of the loan exceeds the net proceeds from the sale of the house, the bank is simply out of luck—it cannot come after the family members for the shortfall.

Thus, a reverse mortgage may make sense for you if:

You find yourself short of cash each month;
You would like to make lifetime gifts to your children or grandchildren and don't have the cash to do so;
You would like to have medical treatment not covered by Medicare or your health plan;
You would love to go on an extended vacation;
Your spouse must move into assisted living; or
You like the idea of drawing down some of the equity in your house without having to repay the loan during your lifetime, so long as you are living in your house.
The amount you can borrow depends on your age, the value of your house, and the current interest rate. The older you are, the more you can borrow, since your life expectancy is shorter and the bank won't have to wait as long to get repaid. Also, as interest rates rise, the amount you can borrow decreases.

However, it rarely makes sense for a single person who may soon need nursing home care to obtain a reverse mortgage, because as soon as they move out of the house, the loan will have to be repaid. That will cause the house to be sold, exposing the cash that had been protected by the home exemption. Then you have to figure out what to do with that cash so that the person qualifies for Medicaid!
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Thank you for your suggestions, igloo572. Yes, the meeting on the 3rd is a care plan meeting. We met first on June 6, 1 week after she was in rehab. it says it's to develop a new plan or review the existing plan. My sister & I will attend & definitely have questions. When I saw her medical file, it had a list of 6 or 7 items, the first or second being Alzheimer's/Dementia. I really do like the staff & I've talked with everyone from PT,OT,nurses, CNA's, admissions director & the one who goes over the Medicaid. I always let them know how much we appreciate how kind and caring everyone is to mom. The CNA's and nurses all love my mom and a nurse just told me today that my mom is always nice and seems happy. I just pray this doesn't change when we tell her she needs to stay there. That is going to be so hard. Thank you.
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She will need to have a physicians orders that "skilled nursing care" is needed in order for her to meet the "at need" medical requirement for Medicaid.

If she was in rehab post hospitalization then she probably has the hefty medical chart that shows need, so orders can be written by the medical director of the NH where the rehab unit is. If not, then she may need tests done or other evaluations done to get the orders and the medical chart to show need. Like for me, my mom was in IL and did the hyperspace move from IL to a NH avoiding AL or a hospitalization/rehab situation, for mom it was more of a chart building process that took about 5 months. If yours is in rehab and not progressing, she can get orders done pretty easily I would think.

The meeting next week on 7/3, is that a care plan meeting? if so you may want to write down any ?'s or concerns you have so you can bring them up at the meeting. You may want to have someone go with you to take notes. Once they are in a NH, the care plan meetings are every 3 months. They are really good as usually there is someone from each area there (nursing, dietary, activities, social work) but usually neither the MD/medical director nor the DON (director of nursing, she is the goddess & ruler at the NH btw) come to the meetings. So if your wondering what arts & crafts could happen, or outings, or what the medication schedule is, or how she deals with cardiology issues, this is the time to ask and get group input. The plan is written down and you will be asked to sign. SO if there's something you want done, you put it in in the tiny space above your signature. My concerns with my mom were dietary issues and they did get on it and change what her meals were like.

Good luck in all this. It sounds like you've got her in a well managed place. Try to develop good relationships with the staff and it will downstream into good will for them in dealing with your mom.
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Thank you so much for all the input. This is all new to me but I've learned a lot in the last 10 days about Medicaid. I've been very fortunate so far in getting the info I needed quickly and having positive experiences. My mom is really in an excellent home and the long term unit is on the same floor with familiar faces. Everyone there has been awesome & they all seem to really care for my mom. We will be meeting on July 3 for her review & hopefully have a plan. I'm a little nervous because one of the CNA's told me there are currently no beds in long term but 2 women are staying in rehab unit waiting. The rehab unit has 16 rooms & only 8 are occupied right now. The lady who reviewed her Medicaid app said she had some forms for me & forms to send to the nursing home. Tomorrow i will find out what these are about, wondering if a form is for NH doctor. He's really only seen mom once when she arrived. We accompany her to the cardiologist. So is the NH required to send a form to her primary doctor or do I get a form for him to fill out about her dementia & health concerns?
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Alderroost

I might remind you that you probably live in a different area than us and we know what goes on around here if you ask enough people, and it really doesn't take long to start getting nightmare stories. I'm not going to backfill on this one because even I have had my own problems but not necessarily from medications. In fact, what my friend had to say I know he was telling the truth because he just told me last night and I happen to believe him. I may not have reactions to medications at this time, but there's always a first time as they say and I take each story about the downfalls of poverty and experiences from it very seriously. In fact there is another situation where an elderly friend of mine was hospitalized many years ago right before he died and he also happened to be poor. I think it was a respiratory infection but back in the day of spring mattresses in hospitals, they also had better ones. In a room of two empty beds the less expensive one was definitely the innerspring mattress. The other one was a pressure relieving sand bed as they called it back then but turns out to be the early versions of Tempur-pedic or space material. His insurance would not cover that other bed. When you live in poverty there's no frills for you and yes, you really are treated very differently, these are our observations.

In fact there was another situation and untold stories of the ER. They really wanted to cater to this Catholic nun who helped open the hospital and from my observations, she was treated more like a VIP, which I can understand to a point. However, let it be someone else with a screaming patient next-door then we must tolerate it. Yes, the rich are treated better around here and seem to be more credible and this is why I am giving off this morning because I've seen it firsthand and I have also heard other people's stories. Based on what I saw firsthand these people are credible, and a whole bunch of people saying the same thing aren't lying. I can't just step down and back off and let things go on without speaking up and saying something. I must speak up and send out a warning where necessary and this is just one of them. Be very wary of admitting your loved one into a Medicaid facility. i'm not here to fight with anyone but just to simply send off a warning and this is where I stand. If I see something and don't say something I'm just as bad as the wrongdoers, and I don't tolerate people being treated unfairly just because they're on public programs, so am I for the time being. Putting myself in the shoes of someone else needing a facility that takes medicaid, I would be very reluctant to go and would probably be forced to go kicking and screaming and all the way there and fighting tooth and nail until someone bled, that's just how bad some of these places really are. And don't get me started on what I saw going on in the facility about my foster dad! Yes, there's abuse going on in that specific facility, I saw it with my own two eyes. My foster dad also happens to be on public programs and I saw him get jerked around just like I saw another place and get jerked around and abused. Oddly enough, my foster dad happens to be on government insurance. Yes, there is considerable mistreatment against the poor around here, and it's not right and I'm definitely not one of those kinds of people who stands by and says or does nothing! Before this turns into a downright fight on here, I'm unsubscribing from this particular question because things are starting to get upsetting despite my best effort's to warn what goes on out there in the world. I've seen it and heard other people's nightmare stories and a bunch of people saying the same exact thing based on what I saw are definitely telling the truth because they themselves have been through it. Most of you out there can't even get as far as I am now despite where I've been, you have no idea because if given my situation you wouldn't even get near as far as I have nor would you have even survived what I had to survive. If you experienced half of what I was through,  you would know what I'm talking about. It takes someone else who is been there to be able to understand but obviously many out there just don't but all I can do is warn others to be aware. Potential residents, beware! that's all I have to say and I'm not changing my story
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@Dontask4handout: The class action law suit was against the name brand? Then your friend might have had a bad reaction to the name brand the same as the people who sued. So please take that kind of concern and upset about not being treated right with generics off your plate. It sounds like you have enough else to deal with. Sorry your friend is having a hard time of it.
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Hi JoAnn29

You're just fortunate you had it that's great because so many people out there don't, but I'm glad you had it as good as you're describing. There have been so many nightmare stories around here where people just don't have it that good and it's just a fact. Not everyone is as good as your daughter or her facility and not everyone is fortunate enough to dodge damage is done by medication that should've been helping. My good friend who lives only two streets over can tell you his experience on what the generics did to him because he was permanently damaged but when investigation was done, he got the sad news he could not participate in a mass lawsuit for the medication that was substituted for generic because he was taking the generic. In other words, he was screwed and over the barrel without Vaseline, so he was royally screwed. He's now in a wheelchair because of the damage the medication has done and I pity anyone else who faced this same similar fate. In my opinion, I think that if you can reverse your own conditions, your stand a much better chance of being able to get off of medications when you no longer need them.

Years ago I met two ladies who were roommates in a nursing home. When I heard their miraculous stories about reversing diabetes, I was shocked and amazed because they were actually helping each other and they were sticking to a very strict healthy diet. One lady was able to successfully go off of her meds and the other was nearly off. Yep, they did this together. From my observations, it takes another person with the same condition to be able to go through it with you, and if it can't be reversed, you can learn together how to cope. Learning how to cope later and enables you to be able to help others with the same condition.

Again, I'm so glad you had it as good as you described and we need more cases just like yours because there just aren't enough of them. We trust doctors to give us the right medications to actually help us, and nursing homes to treat us right when we or our loved ones land there. Sadly for many, this is just not the case. Perhaps reading up or watching videos about the many sad stories of nursing home abuse will open peoples eyes because no one has any business abusing our elders even if they won't live much longer anyway. They have the same rights as everyone else to live a safe and peaceful life and the golden years should be the best of all. However, this is not true for a good many people out there as they are often divided into class and treated accordingly. In fact, as for the Medicaid situation on where they won't cover nothing more then they absolutely must, I knew someone who needed a power chair and to the best of my knowledge he only had Medicaid as far as I knew. When it came time to get him the power chair, it was a total piece of crap that would not do very good outdoors. I eventually ended up with this chair and found out for myself the hard way and was it a nightmare! When I compared other chairs more suited to the outdoor environment, there was a huge difference. I eventually ended up with better chairs for outdoors and never again wanted to take these other chairs that were more suited for indoors outside. More times than not, you only get the good stuff if you have other insurance coverages or just better Insurance and even some self-pay. I've just noticed this around here where I live because Medicaid is not going to give you a high dollar chair if they can just get away with giving you a piece of crap for as cheap as they can get away with. This is just a harsh reality around here like it or not, that's just how it goes around here and many people have had their own nightmares with Medicaid and getting good stuff. Being single around here put you in a worse position because you're far less likely to get what you really need unless you pay for it yourself if you have no family support. In some ways, being single does have its perks but in other ways it's a curse! Family support is the same way because there's good and bad. When you have no family, it's pretty bad for you around here because it's usually family who step in and help but not in all cases where some people are just downright greedy. Where there should be community helping people in need, there's just not that kind of support, especially when you need something major like a car. I've been riding around on a mobility scooter for quite some time because I can't be on my feet long and a mobility scooter can only do so much and go so far. When you really need a car and you're about $800 short of the minimum income to get a car loan, you're screwed when you have no support in helping you. This is why so many people around here are in traps they can't get out of and all because of a lack of income and support. Add being disabled to the mix and you're in a worse jam, especially when you need a car or some other high dollar item. Power chairs and mobility scooters can be bought cheap if you know where to get them but cars are a different story because you just don't want to buy something that looks like it's going to break down and you definitely don't want a lemon
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My daughter has worked at rehab/nursing facilities for 20 years and she says her patients are treated no differently when private pay then Medicaid. When it comes to generic vs name brand, the insurance companies usually only pay for generic unless there is no generic for the brand name. A doctor has to submit a request to the insurance company telling them why the patient has to have name brand. Now, my nephew was not on Medicaid for a nursing home but he was on for his Medications. They wanted to change him to another med for the same problem, but he only does well with the one he has. His doctor was able to explain this to the insurance company and he was allowed to continue with his med at a higher cost to him. Also, we found that by paying $5 extra a month (later went up to $16) it put him into a different terr and he was able to get the med with no problems.
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My daughter has worked at rehab/nursing facilities for 20 years and she says her patients are treated no differently when private pay then Medicaid. When it comes to generic vs name brand, the insurance companies usually only pay for generic unless there is no generic for the brand name. A doctor has to submit a request to the insurance company telling them why the patient has to have name brand. Now, my nephew was not on Medicaid for a nursing home but he was on for his Medications. They wanted to change him to another med for the same problem, but he only does well with the one he has. His doctor was able to explain this to the insurance company and he was allowed to continue with his med at a higher cost to him. Also, we found that by paying $5 extra a month (later went up to $16) he put him into a different terr and he was able to get the med with no problems.
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Make sure you are working with the Case Manager at the NH. She is responsible for the discharge plan for your Mother. They will take family comments into consideration. Make sure they agree with you that she is unable to live independently.

Also be clear that you are not able to take her into your home. If they talk you into taking her into your home or otherwise discharging her into your care for a "few transition days," then this becomes your problem. Right now, it is their problem to get her into a safe environment.
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I don't know if you know this but it may not always be in someone's best interest to be in a nursing home under Medicaid and I'll explain why:

Though not everyone needs a nursing home, some do. They're having a nightmare stories of nursing home abuse and when someone goes in under Medicaid only, they may not get the best care, service or supplies they need. It's believed that Medicaid and even Medicare are broke or going broke when they won't cover nothing or very much anyway. Let's say you need a wheelchair. Medicaid has been known to give you the absolute cheapest one possible. Now, let's say you need a cushion for that wheelchair and you happen to need one that happens to be a water or a water to gel cushion. Medicaid won't likely cover it but will most likely cover a much cheaper cushion for that wheelchair.

Let's say you need a certain type of medication. If it's namebrand, you're most likely to see a substitute for that medication. A friend of mine told me a situation where he was damaged by a generic medication because it was given to him as a replacement for the original. When it did some kind of damage to him, he was not able to participate in the mass lawsuit because it was a generic medication. This is far from right because this person now has permanent damage from the generic version of that particular medication. Had it been the actual stuff, he never would've been harmed
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I live in NJ. You need to talk to the finance person. She can be evaluated for the NH section and with her health problems should be excepted if they have a room. Financial should be able to help you with Medicaid application. Do not take her home if u can help it. Going from rehab to the NH is the easiest way to get her in. In the Medicaid application, its her primary that fills out the doctor forms. Not the tempory facilities doctor. Once she is in the nursing section then you can chose the facilities doctor for her care.
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Medicaid will pay for assisted living (she will have to share a room), ...at least it does in Idaho. I have had my father-in-law in the hospital for the same thing your mom had, then in rehab, then to assisted living, then back to his house and finally to a nursing home (where he originally was for rehab). All in a matter of 6 months. I handled all the paperwork. The house will have to be sold and the loan paid off. She cannot have more than $1999 in a bank account. When she qualifies will depend on when these requirements are met. The usual time is 30 days after she is approved. She keeps her social security, but her portion of the monthly payment to the nursing home depends on her social security, but it usually is all but $100. The nursing home will pay for all meds (except over the counter drugs), and most everything else. Each nursing home has to fulfill a certain amount of Medicaid patients but no more. It is up to the nursing home after they fill their quota. The facilities along with our social security representative helped us thru the process. FYI: you MUST have a doctor approve your decision first. Medicaid is pretty firm with their rules and there are no exceptions.
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Sounds like you have gotten great advice here and are doing your utmost for your mom.

I'm in a different state where person permanently leaving their reverse-mortgaged home means that the bank requires the home to be sold. Any proceeds would then be available for NH care. That may "sweeten the pot" for the NH. But maybe MD is different. Just thought I would mention it.
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Thank you! I just received a call from our local DHHR office & she was very encouraging about her being accepted for Medicaid. She had gone over the application & said because I had just about everything needed, she could possibly be approved by July 1. I was shocked! Now hoping the NH accepts & can transition her from rehab to long term. She is in the best home in our area & I would not want her anywhere else.
Yes, the cardiologist is aware of dementia. She has an appt with him on Thurs, hoping he can make recommendation. Last visit, I was told it would be dangerous for her to be home on blood thinner, although I realize she could fall in NH. The nurse practitioner said we as a family should decide blood thinner risks of falling & bleeding vs. no blood thinner & risk of stroke. That's not much of a choice.
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There does appear to be a plan in Maryland for Assisted Living for some seniors, but, it looks like there might be a waiting list. I'm going to send you a link by PM. We aren't supposed to post links on the thread. However, I would follow up with someone who is in charge of accepting applications for the commonwealth of MD, because there may be another option. Seniors, who have medical issues and dementia often go into a special category, because their needs are so great, though, they may not need skilled nursing care. I'd be careful about listening to info from a lay person.  

Still, I don't see how they can insist you provide her care.  It's based on her ability to pay and something will have to be done, based on her need and ability to pay. 

And if you are her Healthcare POA, do you have the option of finding a Geriatric Primary? They are more experienced in treating seniors and those with dementia. Did the doctors who suggested the pace maker know she had dementia?
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She is in Maryland. I have let the NH know our concerns and how we feel she should be at home. The NH has their own doctor, the only other doctor she sees is cardiologist because she did get the pacemaker on 5/23. I will ask to talk directly with the NH doctor. I know Medicaid does not cover assisted living & she does not have the funds and that would be risky too for fear of falls. She's on a blood thinner. Looking in to all possibilities! Thank you for your suggestions.
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What state is she located? Has her doctor said that she needed nursing home care? I think that is required if she is seeking Medicaid to pay for it. I'd explore that. Also, you can explore a second option. If she doesn't need skilled nursing care, like in a nursing home, you can see if her state has benefits to cover Memory Care or regular assisted living. Some states provide that based on income, assets and NEED as prescribed by a doctor. usually people with dementia qualify since they cannot live alone unsupervised and are not able to take care of their daily needs. I don't think all states provide it, but, I'd explore. Often the terms are similar to Medicaid.

Are you planning for her to get a pacemaker?

I'd make it clear that you are not able to take her from the facility and provide her care. They'll need to figure out what level of care she needs, which facility would be best and how she'll pay for it, based on her ability.
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