Grandma has no family left in USA. All her children have past away. I am her responsible party at the nursing home as there is no one else to help her. Most of the time I don’t understand what happens due to time differences.
Her LTC is being paid by Medical now as she has used all her other resources.
The Nursing home mentioned that she can go into Board and care. From my understanding board and care is not paid by MediCal and MediCal won’t pay for assisted living.
I need guidance on what to do and how to help her. Grandma is diagnosed with vascular dementia, COPD, hypertension, diabetes and brain eneurysm. She is mobile however is cognitively impaired.
I don’t have power of attorney and she does not receive any income due to being in LTC.

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If she is getting Social Security $ , she actually does have $. The issue is that Medicaid/ Medi-Cal requires gran to pay almost all that mo. income to NH as required co pay. The facility is getting her SS$ as her copay. All she can keep is small PNA - personal needs allowance - of $35 a mo for CA. The pna $ is getting put into a trust acct at NH that is used to pay for stuff not covered by medi-cal, like beauty shoppe. At $35 mo, it’s getting spent at beauty shoppe easily in full.

The issue for gran isn’t MediCal financial eligibility but MediCal medical eligibility. Medicaid is “needs based”; and most of the time the issues are gifting of $ & assets. These are dealt with by the dpoa or family. But Grans issue is medical, she’s just not meeting “at need” for SNF. Medical at need is lots harder to deal with as it’s gonna need medical stuff done, like needs assessment, MD visits, health chart review, updated testing & labs done, new co-morbidity found. If where she is won’t take the lead on this, it’s gonna be hard to do even if you were there. But a court appointed guardian can get things done if she becomes a ward of the state.

Ward if the State is actually done lots more than folks realize. It’s an action done in my experience in probate court. Seems to be initiated most of the time by a mandated reporter (social worker, counselor, police, APS) to court asking for an emergency hearing or appointment by the judge of an interim guardian for the individual. I’ve been an executor x3 and sat thru various ward hearings while waiting what I was there for. Judges or thier staff tend to have a vetted list of at-the-ready Independent guardians to do this. The appointment maybe for 90 days or 6 months then a fresh hearing.

here’s my understanding of it, an individual has an issue for which the state has a vested interest either for safety / security of a resident of their state, or in a state supported facility, like a NH or jail or prison. Your gran is citizen of CA & on California Medicaid program (Medi-Cal) so state has interest or “standing” for her. If there is no family to serve as guardian or family is not viewed as responsible by the court, court can go with an independent guardian. The guardian then has full legal authority to do whatever needed to get the individual placed into an appropriate facility. If there is a board & care home that will take her monthly income, then guardian can move her there. Or a MC as Worried suggested. Or guardian has fresh needs assessment done for gran and Voila! gran is found ok for SNF so moves into NH in adjoining county who has open Medi-cal beds.

Sometimes family wants to be guardian but court decides that is not in the individuals best interest. Like family has no solid source of income, or felons in the household, or family not a resident of the state. If you live abroad, I’d guess you’d never get appointed guardian as judges want guardians, like Executors, to be able to appear in their courtroom
in short order, no excuses if need be. Now you could hire (5-10k) an atty to file for guardianship on your behalf but with local atty as named guardian.

If you should move back to US & want to become her guardian, you can petition court then. I sat thru hearings where the usual person to be guardian appeared in court but getting deployed so not available for year + so temporary guardian named instead. My point is that court appointed guardian situation is not necessarily adversary but out of necessity.

Did you possibly sign off to be financially responsible for her care? If MediCal isn’t paying for her stay, that NH will be on the hunt to find someone to pay her bill and turn over to debt collection. Find the admissions paperwork to see how much exposure you might have.
Good luck.
Helpful Answer (3)

Medi-cal will pay for memory care. Perhaps you could have her evaluated for that? You say she has vascular dementia, so while she probably doesn’t need skilled nursing care, she could probably go to memory care in an assisted living which again, medi-cal pays for.
Helpful Answer (2)

Your post clarified that Medicaid is paying her stay. U.S. Medicaid approved nursing homes are mandated-by-federal laws to never evict a resident with zero place to go. If you signed a legal document, every piece of that document, and eviction notices must adhere to U.S. federal laws.
***Your next step is to locate the Medicaid Long-term care evaluator in the area of that nursing home.

Since your grandmother is enrolled into a MediCal (Medicaid), every 6 months she is evaluated for Long-term Care eligibility, by a person who is contracted from outside the nursing home to do those evaluations.

Since you signed a doc that makes you legally responsible for payments. You should be getting notice of those evaluations, which usually describe the results of that assessment (if the Medicaid person still needs long-term care services. That evaluation determines if she needs assistance with daily tasks. dressing, toileting, showering, moving from bed to wheelchair (transferring), etc. If she still needs help with ADLs then she would be approved for Medicaid to keep paying.

That LTC evaluation will have the contact information of the person who evaluated your mother. Contact that person.

If you got a notice from the Long-term care determination/evaluation person, that says she does not need long-term care. Then the facility needs to ensure that your grandmother has a safe place to be discharged into.

Unfortunately "shoulds" often don't equate to procedures happening. If your grandmother has zero place to live, which usually happens because the U.S. government is nothing like the U.K. (the U.S. forces its elderly to spend-down/deplete their assets), then the social worker should be looking for the place to where your grandmother will be discharged

At this point, it might be that the nursing home is expecting you to pay for her stay. Since she was at first a private payer, the nursing home will do what it can to get you to pay the higher private payer rate. You were not specific about her location, which is fine, but that facility might be hiding that it has more levels of Medicaid approved care; sales drives that revenue stream.

Your grandmother should have a long time ago submitted a social security application SSA, SSDI or SSI.

Medicaid has fewer approved Assisted Living facilities, but Medicaid Assisted Living facilities do exist, many separate from LTC facilities. My facility has Medicaid residents in its LTC wing, but the facility on purpose did not seek Medicaid Assisted Living "certification," due to its preferred higher revenue stream from private paying revenue residents.

Meaning that, facilities with Medicaid approved LTC facilities exist without Medicaid approved assisted living housing, which means all Assisted Living residents pay higher private payer rates, when Medicaid approved only LTC

***As mentioned your next move is to contact directly the off-site person (not employed at the nursing home) who evaluated your mother's Long-term Care needs.
Many state's Long-term Care evaluators are responsible for evaluating people in multiple counties, so google which County the facility is located. what?? Her facility is located in a town that is located within a county that is located within California.

***When you find the person who evaluated your grand-mother, ask the person what made your grand-mother ineligible for Long-term Care. If your grandmother is a "fall risk" then she should still be eligible for LTC. Ask that person for a list of Medi-Cal (Medicaid) approved facilities that would meet grand-mother's needs (usually a social worker's job).

The facility where I have had the most experience will do whatever to get Medicaid people to move out when they have a private payer needing a LTC room.

Your mother's facility might be hoping that you're going to pay for her higher priced Assisted Living at that facility.
***Contact your county Medicaid office, to get the date they approved her Medcaid
Helpful Answer (0)

Her LTC is being paid for by...who? Medical insurance, Medicare, Medi-Cal (which is California's Medicaid program).

Why can't she stay at the NH on Medicaid?

Are you truly signed on as the "responsible party"? That specific terminology means that you signed to be responsible for her bills. I'm hoping you didn't sign as that.

Call the Social Worker at the NH today (get up early or stay up late) and find out what THEIR plan for your grandmother is.
Helpful Answer (4)
AshKiran Apr 2020
Hi Barb
thanks for responding

Her LTC is being paid by Medi-cal

She is being discharged because according to the NH, she no longer needs skilled nursing care .

Yes I signed as RP on behalf of grandma . I was visiting there when she suddenly got admitted in hospital and then was discharged and placed in NH. Everything happened so suddenly and because I don’t live there I wasn’t aware of the rules .

I have woken up early and left multiple messages for the social worker however they never return my call and since September of 2019 there has been 4 different social Workers.
You need to ask the nursing home about starting the process to enroll her with "medicaid", but not all facilities accept it. You might also consider having her become a ward of the state, I'm uncertain if it is possible to do that temporarily due to the current inability for you to travel. Hopefully some of our American members will come along soon and help you with the details.
Helpful Answer (2)
AshKiran Apr 2020
Hi thank for responding
Who can I contact for ward of state questions? Is this something that can be done by me from overseas ?
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