My dad and his companion have been living together for approx 30 years. He his 79 and she is 73. He needs assistance showering, dressing, eating, and walking. Her health is also declining. My dad does not have ANY assets. The house is hers. He is on Medicare and receives Social Security. I did try to have therapists go to the home but his companion is not in favor of letting strangers in her house. Since it is her home I feel I must comply with her request. How do I start the process of getting him into a nursing home?

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Medicaid rules are determined by each state & are state specific even though it is a federal & state program. Dad will need to qualify both financially AND medically. Medicaid is needs-based. Your dad is expected to spend his assets first and foremost before the state will pay. It sounds like he is already under the 2K/2K for financial. The next part will be how to find a NH and qualify medically.

In general for NH Medicaid eligibility, an individual must show that:
1) are 65+,
2) have medical conditions that requires that level of nursing care,
3) monthly income at or below their states max (about 2K),
This is the “income test”– how much $ do you make.
4) all countable assets are at or below 2K
This is the “asset test” – how much $ do you own.
5) not gifted away anything of value during 5yr look-back period.

If you do, could be a “transfer penalty” when items are gifted. Penalty different for each state as it’s based on each state’s NH reimbursement rate. For TX, it is $ 142.92 a day rate.Max look-back is 5 yrs. You will need his insurance, funeral and burial polices as well as all banking and retirement documents. Most states require 3 – 6 mo. of financials with initial Medicaid application. Can require more.

Most NH admissions come from a hospital discharge to a NH. Admissions at most NH submit the Medicaid application for the resident to the state and most NH already have caseworkers assigned to their facility. You want to make sure that the NH does "medicaid pending" otherwise you will have to private pay for the interim until his application is processed which could be months.

I think the sticky part for you for your dad will be getting him accepted medically.
If they are living at home and need to move to a NH, you will need to work with their MD to get the criteria in their medical history to show they need skilled nursing care. Just because they are old, or have dementia or incontinent, or need assistance with ADL's etc. are not enough. My mom went from IL to NH and bypassed going to AL. She was able to do this as she had a critical weight loss (more than 10% in 30 days), critical H & H and some other conditions. If she had not been with critical weight loss & h/h, she would have been denied. Sometimes their MD will need to change their meds – like go from Exelon pill to Exelon patch (more “skill” to apply); or change a med to one that needs to be compounded daily which you can’t do at home. Each state has it’s own criteria for admission under Medicaid. They will be evaluated at the NH and often those coming from home are denied because they don’t have enough “critical” conditions because there is no history of a need for skilled care when living@ home. You will have to work with NH and your parents MD’s to get whatever done to establish the need for NH if they are coming from being at home. There is a whole medical appeals process in each state for this and separate from the financial appeals. For those still living at home without a huge disease history, becoming a patient of the MD who is the medical director of the NH is good as they will know how to create & write up the health history chart so that it passes Medicaid medical review. Good luck and keep a sense of humor.
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If your dad and his companion are not married, and he has no assets, he may actually qualify for Medicaid assistance, and that may be the route to take to see about getting him either at home help, or into an independent living, or assisted living. I am in the process of doing the same thing for my husband, who had a major heart attack, and then a stroke, and then epilepsy eight years ago. The website is not a bad place to start. THe bureau of Elder services in your state can also point you toward whatever agency would begin the process of qualifying him for services. He will be assigned a case manager, and that person can really help you to navigate the system (which is MESSED UP!) and get through the paperwork involved in getting the necessary services.
Most of those offices are underfunded, the workers overworked and underpaid. Make copies of everything, insist on receipts. It's best, with Medicaid, if you drop off the paperwork in person, and if they are computerized, very nicely ask if they can scan in the application while you wait, and obtain a receipt. If they ask, tell them your case manager suggested this ; ) Less chance of documentation being lost. They will request additional records, essentially proof of indigence. But once the paperwork is complete, he should qualify for most of his basic needs to be met. Then, it's a question of a space opening up. Depending on the state, there is likely to be a wait-list, so I would get on now, and list him as "medicaid pending". Let us know if this is helpful, and how the process goes. I'm sure you/we are not the only ones going through this...and shared information will help all of us. Knowledge is power!
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