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?
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
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.
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.
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.
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.
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.