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Mom is 92, uses a walker, has early dementia and is starting to have bathroom issues. She lives with her son and daughter-in-law and often is very nasty to her son, accusing him of stealing. They work all day so she is home alone for long periods of time and with everything going on the dr. Feels this will have to change before too long. She has no assets and very little money. Has anyone dealt with this situation?

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Wow igloo 572! Thank you! I spoke with Senior Planning Services today. They will do the Medicaid application and all the research required as well as help with placement whenever or if ever it is needed. Fee is not cheap but can be part of spend down. I will keep all your suggestions/advice in mind! Good luck districtgal with your parents. My mother-in-law doesn't have enough money for a facility to start with so no surprises....it's Medicaid or no facility!
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One item that gets overlooked in the mice maze that is Medicaid is that they have to qualify medically for skilled nursing care. So much of Medicaid concerns is focused on the financial / spend -down / transfer penalty concerns. But for Medicaid, both "at need" financial & medical is required to be eligible. How your state does this varies.

If they are a private pay admit, the facility can be lots more flexible on the need for skilled nursing. This is a factor as to why some places just do not participate in Medicaid.

Majority of NH admits are via rehab from a hospitalization so medically at need clearly in fat medical file. For those trying to admit coming from home or IL, that is not there. When I moved my mom from IL to NH (totally bypassed the whole AL phase), the state sent out a nursing team to NH to evaluate whether she qualified for skilled. Yes she had MD orders for skilled but still state did review. She was denied so an medical necessity appeal needed to be done. The issue was the NH CNA intake did not put down all of moms medications, now RX were done but did not make it into her chart. (btw this was the start of the issues with NH #1....) When state came to do their once over of mom 2 days after her admission, only 1 RX in file (she had 5). It took about 4 mos to resolve the medical necessity appeal, which the NH has to do (as they control the chart) although I as my moms MPOA had to request. So for my mom 4 mos to clear medical & almost 6 mos to clear financial eligibility for Medicaid. Now NH took residents as"Medicaid Pending" but only for a 6 mo initial period.

When looking at facilities, having them at one that does "Medicaid Pending" is mucho importante. It seems that facility can take Medicaid but not do " pending" or can limit pending period. You need to be very clearly understanding of just how the NH does this and what is expected if it goes amiss. Whatever you do, sign only as "Jane Smith Jones in her capacity as DPOA for Mary Smith" on every document and do not pay anything till you get a copy of all documents. Over & over on AC there are posts from family who sign mom in as DPOA but don't get a copy of the stack of paperwork. If it goes bad, it's a $ 100,000.00 debt.....get the paperwork!

You know there will be a NH with an open Medicaid bed somewhere. It may not be your first choice, but you can get your elder in; get through the Medicaid maze; then move them to the better/closer NH that you have your elders name on their waiting list. Once their eligible for Medicaid, transferring from 1 Medicaid NH to another is pretty straightforward paperwork. If you go this route, couple of helpfuls: get all of their medications & go prepared to do this; do NOT have the NH get their SS, retirement or any other income as its tough to stop or change direct deposit at will; you need extra hands on the morning of the switch to the new NH; be sure to zero out or have it at $5 or $10 in their personal needs trust fund at the old NH. (for MIL her NH held the personal needs $ for a year before mailing a check to BIL). For my mom, NH #2 allowed me to go in the afternoon before and set up moms room with photos, TV, linens, clothing, chest of drawers, etc - mom just needed to be there by 10:30 AM the next day. If mom had needed an ambulance to transfer, they would have arranged for it too but mom was totally ambulatory. If they are on Medicaid, the state pays facility by day rate, so no repercussions on not a full month at a facility or need to do a 30 day notice. I did a 2 week notice as I only paid NH #1 for moms copay for only those days there & paid NH #2 for her days there. NH #1 was peeved abt the move but not my problem.

In looking back at all this (I'm going through stuff & jettisoning as mom has died), being organized is the key to your sanity. Invariably paperwork goes amiss and whatever it is needs to be faxed/sent within 72 hrs. Get a list of the required Medicaid documents; start a binder on financial (bank statements for at least 3 years, their awards letters; insurance policy; funeral stuff); one on legal & medical (like all those mailings from CMS); if they have a home then one for house items. These binders you update regularly. For my mom, Medicaid did an annual renewal in which many many items submitted with the initial application had to be resubmitted along with the current mo bank statement & 3 prior months and within 14 days of date of letter. And every year letter was either received after due date or a day before due. I wouldn't be surprised if 30% of renewals get denied for lack of on-time submission; it makes state resting look good in finding ineligibly
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I am also going through the same thing for both of my parents. Both have dementia. Moms name came up for Medicaid but not dads. I have not heard the progression of moms application. That was from April. I have them in a assisted living facility that accepts Medicaid when the time comes. I am getting very nervous what to do because their money is almost gone. They also have no provision for funeral expenses. It's unfortunate that things are so stressful and difficult when trying to help your parents. The advice to start early is great advice. This may lessen your stress in the future. The sooner the better. God bless. You are not alone.
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I live in KS and my Mom moved to NH from independent living with a short stay in the hospital. The doctors would not release her to anything else and the NH helped get her on Medicaid, filling out the application, telling me what I needed, and filing it for me. She didn't have to wait here either.
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Pamstegma: Here's the thing-if the patient goes from the hospital to the NH rehab bed, they don't always get to stay in the NH (be transferred to the long-term care section). My mother, who was in the NH, was told "you're too well to stay here." INCORRECT!!!!!!!! Less than 48 hours later, she suffered an ischemic stroke there and died!
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What you wrote 126cher does seem to be true! Once Medicaid comes into the conversation they no longer can help. My husband and I got LTC insurance last year and going thru this for my mother-in-law makes me glad we did. We may not ever use it but if one or both of us do need this kind of care it will save my kids some distress...at least I hope so!
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mean sad and said----sorry
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The good AL and Nursing Homes want 2 years at least private pay before people go on Medicaid. Once you are on Medicaid they tell you there is no room. Than a person comes along that is paying on their own and magically there is room. Get Book " Bitter Sweet Season" by Jane Gross. Book tells said truth.
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It's not that they don't accept it...they just have a limited amount of beds for Medicaid patients. So her name can go on a waiting list which is better than nothing (I was told by one facility a 2-3 year wait) but we still would like to see what the place is like! However, because there is such a limited amount of beds as soon as Medicaid is mentioned they are not very helpful...at least so far in my search!
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Kathy, what would be the point in even visiting a place that doesn't accept Mediciad?
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State line isn't an issue...she will stay in NJ. From feedback here it seems that going from hospital to nursing home is much more likely in a timely manner than going in straight from home. I have mentioned when I've talked to some facilities that she may be able to pay herself for one or two months and that doesn't seem to make a difference to them. I also am not sure how much I should divulge when trying to set up a visit if they shrug us off when I say Medicaid!
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If unable to return home: Acute care hospital, sub-acute care/rehab, SNF rehab, SNF long-term with option to return home if injuries permit. We said at each level of care that we would NOT take him home. Each level of care was provided to the extent that Medicare and supplemental insurance would cover. Then one, maybe two months of private pay. Patient is then admitted as "private pay" , then moved to a Medicaid bed - a "semi-private" room when private pay stops. In our community, if a patient is placed in an SNF across the river this is also across the state line. It appears that both states accept private pay so look at medical/ADL issues. Next - each state's Medicaid administers things a little differently. If crossing state lines just be aware property ownership needs to be considered before making the final decision. SNF's will accept the private pay from anywhere. Medicaid, however, looks at location of SNF and location of the patient's home residence. Try to find a facility within her state of residence if she owns any real property. In our geographical area it's easier to get placements across the state line, but more difficult to process Medicaid applications.
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I spoke with A Place For Mom and because our Mom cannot afford private pay for longer than a month or two they could not help us but they did send info on sites to check for Medicaid funded places. If you can afford private pay in the beginning it is easier to find a place. Thanks for your input, though!
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Don't assume there's waiting lists everywhere. We started looking with A Place for Mom and they were excellent in guiding us.
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Thank you Carissa58....your situation is definitely similar to what we are going through. Fortunately there are a few of us to deal with this. Doing it alone must be so hard! At this point I am thinking we will also have to wait until/if she is hospitalized. She also may make just a bit too much for Medicaid. I will have to look into the trust you mentioned. Thank you so much for sharing your experience and good lick to you!
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I just experience that very same thing. Took care of my mom and worked so she spent long periods of time alone, although we have two loving dogs that are always at her side. I think it is for the food she might drop. :) I did this for 6 1/2 years and discovered 3 years into it the very thing you are discovering. There is no one place you can go to get the answers you need to have someone qualify for Medicaid. Wellfare, food stamps and Snap, yes but nothing specific to the elderly. Three years ago after 4 months of pounding the pavement I quit and decided I would keep her until I can't anymore. I just waited for the 911 call. It happened and the idea of leaving her in the hospital was a thought, I mentioned it in a round about way to the social worker and she said the police would be on my door, but thankfully it did not come to that. I do not share this responsibility with anyone, I am an only child, so I have no family help with the enormity of the responsibility. Once 911 was called, she had a stroke, the ball just rolled. The social worker found an acceptable Medicaid pending nursing home. You do need to get an attorney that specializes in senior care. My mom made in social security and retirment income $200 too much to qualify out right for Medicaid so we had to set up a Qualifying Income Trust, that is where the attorney comes in, and the actual filling of the papers for Medicaid. This is the first month, and we are still on Medicaid pending. Hope some of this information helps. Good luck, it's a hard task.
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Thanks everyone for your advice. It is very helpful. We live in NJ so if someone has experience with the NJ system that would be great. One of my questions is whether to sign her up for Medicaid now or wait until/if she goes into a hospital and then to a nursing home. Her burial arrangements are already made and she has an irrecoverable trust set up for her funeral expenses. She has been seeing a geriatric dr for a year and a half who feels she will need more care in the near future so I think she will fill out any needed paperwork. Mom has lost about 10 lbs in the last year and is very frail. She goes back to see the dr. In October so we are trying to come up with some options by then. Again I thank you all for your input...this is very confusing and frustrating!
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I think it depends on the state. In my state of NC, most assisted living facilities do provide assistance to the resident. It's based on their needs. Some do need assistance with bathing, bathroom, medication administration, etc. That is all covered in the monthly fee. You have to find some that accept Medicaid. I looked on line and called around. Then I narrowed it down and physically went to the facility for a tour.
Oh, they have to be able to get in and out of bed with the assistance of one person. If they can't do that, they wouldn't be a good match.

You say your mom has dementia. If her doctor can say she needs Memory Care, she might qualify for a Memory Care facility. They do more things for the resident, depending on their progression. They accommodate the resident with help in all areas of their daily care. It involves a lot more on hands care and I would recommend it for those who have substantial memory loss and may not realize what things are for. And they know how to handle dementia behavior such as the accusations your mom is making. Regular Assisted living places don't do well wit that. In our state Memory Care is still considered Assisted Living.

Nursing homes are also an option, but they costs much more. Still, if your mom qualifies for Medicaid, I would check out places that except it and find one that you feel comfortable with. If your mom is still fairly mobile and has problematic behavior from dementia, that might cause a problem at the nursing home. I'm not familiar with them, but others here are for sure.

I will say that even though some facilities may be pretty and look good, they may not be any better than a more modest one. I would have your mom properly evaluated to see exactly what assistance she needs and what kind of place would be a good fit.

In our state, for Medicaid purposes, the doctor has to sign off on what care she needs. For example, she cannot care for herself in the following ways, and there are boxes to check for what she needs. Such as incontinence, bathing, etc.
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Another thing to start working on is to have her medically qualify for needing a NH. Often when they are living at home or in IL, there flat is not the fat medical file that shows the need for "skilled nursing care" aka NH/LTC facility. For us, it took about a 6 mo run of visits to a gerontologist to establish a history of needing skilled for doc to write orders for skilled. The visit mom had a 10% weight loss and a bad H&H lab report, doc wrote the order fro skilled care needed along with chan ring how some of her medication needs to be done (like Execlon patch rather than pill and changing another med to a compounded RX…both of which need "skilled" to do correctly). Most admits to a NH are from a hospitalization and they are discharged to "rehab" which is done at a NH with rehab unit / services. They come with the fat medical file showing need and come in with Medicare paying for the first 21 days of rehab at 100%. The usual is hip break, surgery and they cannot return home as not able to do ADL's so go to rehab and stay becoming a LTC resident - that's from what I've gather the scenario for like 60% of NH admits for women.

When coming from home to a NH that auto admit & secure payment (by Medicare) is just not there so you are going to have to be organized to get this planned out to be as glitch free as possible. Still a mice maze to do Medicaid but it can be manageable if your organized from here on out on all things mom. Good luck.
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I think it must depend on where you are. Both my mother and her sister got into care facilities on Medicaid with no waiting lists. One is an older small facility as igloo describes and the other is huge and fairly new. Both are providing excellent care. Around here it is easier to find a nursing home that accepts Medicaid than an AL -- and it sounds like that may be what this woman needs.

Start the process of applying for Medicaid and looking for facilities as soon as possible.

If you care to say where you are, perhaps someone local could give you more particulars. Availability of good care for folks on Medicaid varies widely across the country.

Home care isn't really less expensive, by the way. If it were, states would be paying for that instead of facilities. Check into round-the-clock care. You might be surprised at what it costs. Maybe just covering her while her son and DIL work would be less expensive, but that wouldn't relieve them of the stress.
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Really get out there and look at several facilities - often facilities that are somewhat older and not as jazzy looking can provide for better care and have experienced veteran staff. Please ask what documents are needed for the medicaid application, so you can start a binder going on all & be somewhat less in panic mode for the day that she will need a higher level of care that family can provide. If she has limited funds & hasnt gifted $, she should qualify for Medicaid. Before she applies, you may want to see if she should spend down some $ to get a prepaid no cash value funeral & burial policy done.

You can move them from one NH to another too once they are approved by Medicaid. Requires a bit of planning but very do-able.
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Thank you. What you wrote is what I am afraid of....unless she goes into the hospital there is no way we will be able to find a place for her. And even if she does wind up there, abandoning her in the hospital just sounds cruel! I am looking into home care...less expensive but certainly not cheap!
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Assisted Living told us they don't wipe butts and the patient has to be able to walk to the dining hall and have good behavior.
Nursing Homes that intake Medicaid have long waiting lists.
You should look around a year before you actually need a place. So start looking now. Sometimes the parent has a serious fall, gets into the hospital and the family just refuses to pick them up, forcing the Social Worker to find a place with an open bed. It's a way of bypassing the waiting lists.
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