Finding fully Medicaid covered long-term memory care facility quickly.

Derek, I live in Brooklyn. Someone told me that you had posted here, but I couldn't find your post until today.

How are things going with your search for care for your mom?

Below in a reply to me you wrote: "I actually do not want to be her legal guardian and be either legally or financially responsible for her. This was all her idea. How does someone else get named as the legal guardian and where do they come from? Does that automatically happen when you report the person to social services? As you so correctly mention as there are no funds to pay for her appropriate or chosen care I already do not have control." An elder without a PoA or guardian and who is not taking appropriate care of themselves or is a danger to themselves or others is reported to APS (Adult Protective Services). Unless it is an extreme situation, they will need to be reported several times most likely, especially if they live in an urban area where county services deal with a large population. Once things are "bad enough" for her the county will get her on a track for a court-assigned legal guardian and she will then be managed 100% by that person (who usually works for an overarching entity that provides vetted guardians). In my family's case I was working closely with social services and my in-laws. They knew my SFIL needed a guardian and they did a lot of things to make sure this happened sooner rather than later. I was contacted by them once he was assigned a guardian and removed. Since the PoA process can differ by state, maybe others on this forum can respond as to how you end it. I know it will require signing a document but don't know if it's a form you can download for NYS and where to submit it. Not sure how long ago your Mom assigned you... if her PoA was done a long time ago (like 20 years or more) and she didn't file it with the court or any entity, then it may not matter, you just stop acting like you're PoA or telling anyone you are. But I would look into the proper protocol. If you are joint on any accounts with her, not sure what kind of impact this will have in NY state. I would not tell social services that you used to be her PoA, just in case they get judgy about that. Their system is overwhelmed with need. The hard part will be standing by and watching your Mom devolve until the point she is removed into a facility and gets a guardian. But this was my experience in a completely different state (MN) so have tempered expectations of how and when things will happen. If she has any neighbors or a church/faith entity that is close to her, I would loop them in as well just so they know what's going on. I'm so sorry for the shock and distress of this situation. Even people who've lived here their whole lives get surprised by how things can go. I wish you success in helping her get the appropriate care she needs and peace in your heart no matter what transpires.

I found the website aging life care. https://www.aginglifecare.org/
Click on the find button. There are listings in Brooklyn. You need a zip code where she lives

Derek, what you may find is a real issue for the boroughs, is that there simply isn’t enough beds available in Manhattan or Brooklyn. If they exist, they are private pay concierge level type of MC & SNF as plenty of folks have that type of wallet in NYC. Of the 5, those 2 boroughs are oh so HCOLA so for a landowner to own a building to use as a MC or a NH with Medicaid paid beds makes zero sense to do. Repurpose building for $M+/$B+ condos or co-op.

There is such a LTC bed shortage that NYS Medicaid will actually pay for 24/7 in home health /IHHS in some skilled nursing care required cases. fwiw for Medicaid to do beyond its usual in Home / IHHS limit “hands on” 28-30 hours a week maximum is super unusual. It’s done because of the bed shortage.

There is a regular poster on this site who’s from Brooklyn, her & her siblings actually moved their mom from there to a SNF in Connecticut. Hopes she see this and adds her experienced perspective.

As a suggestion, if your mom was to be reassessed and be able to show that she actually is “at need” medically for skilled nursing care, this would give her & you more placement options. Way more SNF/NH beds that take NYS LTC Medicaid than MC beds on the LTC waiver payment program. Plus doing this removes the possibility that couple of months from now, you get a Notice from the MC as to “we love you mom but she needs a higher level of care & this is your 30 day Notice” so you are back having to search NYC for a bed all over again.
I did this for my 90+ mom, moved from IL to SNF and bypassed the AL/MC phase; took Dr visits and labs done in a compressed timeframe but got her chart to clearly show “at need” for skilled. It’s unusual to enter a NH LTC Medicaid Pending directly from living at home or being in IL but can be done. The usual is they enter the NH via a post hospitalization discharge to rehab in a SNF and then determined unable to return home. Reason why done this way is US health insurance will tend 2 pay 1st 20/21 rehab day at 100% so NH is getting sweet sweet higher rate Medicare $$$ and family uses these 3 weeks to find documents & figure out how to legit & quickly spend down elders assets to a mere 2K for most States, so able to become LTC “Medicaid Pending”. (Your mom is lucky as NYS has 31K asset max). Health care in the US is a maddening maze as compared to other 1st countries.

& as an final thought and not to be harsh, imo unless your mom is “young” (late 60’s-early/mid 70’s & was super active till whatever happened to have her need MC), and all her friends are too in that demographic or younger and they too are still super active, she is not going to have old friends visit her. Even if in Manhattan. It just sadly becomes logistically too too difficult. It imo ends up being that to make this happen, on one of your trips in you set aside a full day, get a car service and you pick up 1or 2 of her friends and take them over to see her and the MC/ NH has y’all on for extra table for lunch or pick mom up and everyone has a meal in a restaurant. If you do this, hire an aide from moms place to accompany the group. Extra hands for bathroom detail alone makes it priceless. Best of luck in your quest!

Im Curious, what happens in this situation in France? Are the options any better? As you can see, things are complicated and difficult in USA for this situation. Is there a daily caregiver visit at her current home in Brooklyn that would work? Not 24/7 but daily support? Probably private pay but keep her in familiar surroundings for another year or so? Have you considered a private pay caregiver to temporarily stabilize the situation? Use mother’s funds to pay.

The only way to get immediate service is is by getting a hospital to admit her. If dementia is her only issue, I doubt that happens.

You can search all you want online but your first question should be is if a Medicaid bed is available. For many good ones, it might be months or years on the wait list. Most MCs do not take Medicaid. She needs to go to a skilled nursing facility to qualify. Move quickly here. A call to APS from any neighbor might send her through probate as a neglected person and a new guardian may be appointed. You were alreasy told she is unsafe. You might want to go to her, and schedule a professional elder cate advocate appointment who specializes in Medicaid just before you arrive to expedite the process. Look up the term on Google to choose one. They cost around $200 per hour but they are only needed for a couple of hours. Once she is placed, your presence will be needed to close off her apartment.
If you arrive and she is deemed as unsafe, you can send her to the ER. An admission might find her a facility fairly quickly but you cannot be choosy.

Look outside of Brooklyn. If I was POA and wanted to continue being that for my mom in NYC, and I lived in Paris / London/ Madrid. I’d look for a MC or if she could go into a NH then a NH as close to JFK airport that could meet her level of care and has an open LTC Medicaid bed right now. Really like look in Queens and then eastward to Rockville, Westbury, etc.

You can move her later on if need be. The important thing is getting her placement done while you are in for this. Fwiw I moved my mom from NH#1 to eons better NH#2 within her first year and couple months after she totally cleared her eligibility for go from “Medicaid Pending” to fully LTC Medicaid eligible. It’s a bit of a ballet to do but can be done.

also if she does not already have a pre-need done for funeral & burial, please pls try to get this done too on this trip in. If she has no $, then you figure out what you can afford and get it done. A NH is going to have skittishness on a resident who doesn’t have this and their next of kin lives full time in France.

There are elder care / geriatric care planners who can assist you. Google shows some in NYC. I haven't used one but a friend who had to arrange facility care and clearing and selling the house for her parents from several states away found the service very helpful. There are also professional organizers and senior move managers who can help you with the apartment. I know it's daunting to have to do this internationally and from a different time zone so I hope it all comes together for you and your mother.

You also wrote in a response: "I am hoping that the memory care homes will help me with whatever's necessary to get them paid by the insurance." What insurance are you referring to? Not Medicare. Medicare doesn't pay anything for MC since that is only custodial care. Medicare is medical insurance. Long-term care policy? Does your Mom have one? This is the only other type of insurance that *may* pay something, It's not the MC facility's job to figure out how you will pay them. This is your job, and your job alone.

Below in a response you wrote: "I am both her financial power of attorney and advance health care directive. I am hoping that will help with the process." If there are no funds for a facility this, in fact, may be a problem. The only way to get her MC paid for is if she becomes a ward of an assigned guardian. This may necessitate you resigning your PoA authority. In a different state (MN) my SFIL with advanced Parkinsons and Lewy Body dementia could no longer be taken care of by his wife, my MIL, due to her memory impairment. He had no PoA so I reported him to social services and they eventually got him into a Medicaid facility. He was hallucinating and falling (6'4") and barely able to feed himself. Although the facility wasn't great, there was no other solution. The legal guardian sought our input and opinions about his preferences, trying to maintain "normal" for him and get him things he liked (food, music, clothes, etc). When they first had him in a rural facility that was 1 hr drive we asked he be moved closer to us. The rural place was new and very nice. The urban one was... a very shabby and poorly run county Medicaid facility. The guardian is not your adversary. "Losing control" is not what you think it is -- especially if there are no funds to pay for her appropriate care, you already don't have control.

I'll be honest with you--being POA from so far away isn't going to work in my humble opinion. I was POA and Trustee for my brother who was at the other end of our state, and it was a lot of flying back and forth. From France? That's problem number one.

You say if the state takes Guardianship you won't have choice. Yes, BUT.....
Sadly you already DO NOT HAVE CHOICE as there are no assets here.
Choice stops in the USA when the money is gone.
Almost NO memory cares accept Medicaid payment. They cherry pick and they're privately owned (mostly by corporations and hedge funds). They don't have Federal regulation, only State.
They take private pay patients and memory care averages somewhere between 10,000 and 20,000 a month.
Moreover, because mom has both SS and private pension she may not even qualify for long term care placement under Medicaid; she may have too much monthly income and need a Q.I.T. or Miller Trust written so some of it can be locked away in Trust (with the Federal Gov the beneficiary). Again, lawyer work you must be here for.

I am sad to say I don't see this working for you. You mom would need to enter a nursing home on Medicaid, and that's the point at which there simply is not a whole lot of choice. But a whole lot of WORK.

At minimum you are in for now a long trip here. And a long stay to get things worked out in terms of attorney, placement, moving, and management. She really needs a Fiduciary acting for her as in Licensed Fiduciary.

So sorry. This is going to be very difficult. You sound very capable, but this will put every single bit of that capability to the test.
My very best wishes out to you.

Please contact APS. Google APS Brooklyn NY and it will give you the NYGOV website. In NYS before you can apply for Medicaid LTC she will need to spend down her assets (bank accounts, stock, credit union accounts) to $31,175 (2024 amounts). You will also need to have 60 months of bank statements of all her accounts. Then any withdrawals over $1,999.00 will need supporting receipts. I would highly recommend hiring an elder care lawyers to handle the case if she has any sort of assets over the allowed limit.

If there are no assets and she is truly impoverished, there may be the recommendation to have NYS guardianship to apply for MLTC.

This will be a great undertaking on your part if you wish to remain a financial caregiver (do you have POA?) and you are overseas so that adds even more obstacles to acquire all the needed documentation.

I am currently POA and live 10 minutes from my uncle who is currently applying for M/caid LTC in NYS. It requires many hours of searching, surrendering any assets that are over the allowed limit and paperwork even with an eldercare attorney.

Even though Medicaid is a federal program each state gets to make its own rules for it. Typically once you submit an application and they get all the "proofs' they need/request it takes about 3 months for approval. Medicaid is financial aid to cover medical care. This is why in most states it only covers Long Term Care (LTC) -- because the people who qualify are needing medical care that they can't provide or perform for themselves. This is different than paying for the room one stays in, the food you are served, the non-medical services. This is called custodial care and one's SS income is used to pay for this part of their facility care. FYI being in a facility on Medicaid almost always means a shared room. And, not every facility accepts Medicaid residents, so this is a critical question you need to ask up front. Do not consider any facility that 1) doesn't have Medicaid beds and 2) doesn't include a continuum of care (AL, MC, LTC, hospice services). If your Mom is ambulatory and doesn't have a medical issue that causes her to be bed-bound or daily medical oversight (like ALS, end-stage Parkinsons, stroke, etc) then she most likely will not qualify medically for Medicaid. Then there's her pension, which may put her income above the Medicaid limit. There is such a thing as a QIT, a type of trust you set up for her that takes her "excess" income so that she qualifies for Medicaid financially. This trust money then goes to Medicaid once she passes. If I were you I'd consult with a Medicaid Planner for NYS to see what her options are. I live in MN, and here Medicaid does not pay for AL or MC, only LTC (and then hospice is covered by Medicare). Also, if you are not your Mom's PoA then legally managing her affairs (in her case her pension) may become a roadblock. Institutions won't release info to you just because you're her child. Whatever you do, do not sign paperwork for any facility unless you are her PoA (and then you need to sign a specific way to avoid personal responsibility for the costs). A "last option" if you aren't her PoA would be to contact social services (APS) and report her as a vulnerable adult and this will get her on their radar. This will put her on track to become a ward of a court-assigned 3rd party legal guardian and then all her needs will be met by this person (its not a private individual but they usually belong to a larger organization where there's accountability). Then you will no longer have any control or insights into her financial or medical affairs/decisions (but you are allowed to carry on your relationship unhindered). All her needs will be met in a Medicaid facility, which may not be located in Brooklyn -- only where Medicaids beds are open. We did this with my SFIL and it was a solution that worked for all of us. You need to continue educating yourself on your options and this forum will help you. When you eventually come back you will need ample time, but who knows how long that will be? APS usuallly doesn't remove people until their situation and condition is very bad. I'm so sorry for this stressful situation. It will be hard for a while but then once she is placed, at least she will be in one place and getting shelter, food and personal care. Please have tempered expectations. I realize you have time constraints but the wheels of the govt grind ever so slowly most of the time. Work well with the social workers -- they are advocating for her.