Step by step, how do you get someone into a nursing home and on Medicaid assistance for long term care?

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This is for my son and DIL; I volunteered to help them research their solutions. Her mother has lived with them for the last four years. She is only 82, but is totally blind and has fairly advanced Alzheimer's. She needs round-the-clock supervision and help with all of her activities of daily living, and they just can't do it anymore. My DIL has developed a serious medical condition, my son is at full stretch taking care of her, their son, the household and the finances. My co-mother-in-law's only income is her late husband's social security; she has no savings or assets; her only real estate is a rural property on which she is a tenant-in-common with her sister (also blind) The "kids" understand the basics: documentation needed, look-backs, future Medicaid lien, etc., but the question is how to start to process moving. Is the first step to get a recommendation from her doctor? To apply to Medicaid? To find a nursing home? All of these simultaneously? Should they have an attorney's help from the beginning?

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Igloo, Thank you so much! You took a lot of time to write that answer, and I appreciate every minute of it. This is all helpful.
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Most NH admissions come from a hospitalization stay. They go from Medicare paid for hospital and then get discharged to NH for "rehab" and Medicare pays for the first few weeks and then if it looks like NH is the long-term solution, then they apply for Medicaid to pay for the long term stay. In this process, there is created a nice fat file of medical documentation of the need for skilled nursing.

When they come from home, that usually doesn't exist and you have to find a doc who will work with you to do this. I moved my mom from IL to a NH and bypassed the whole AL. IL is kinda similar to being at home as there isn't the fat medical file.
My mom's gerontology group has doc's who are also medical directors of NH - so they know how to work up a file so they can pass the medically needed aspect. There are simple things: change a medication like Exelon from a pill to a patch as that requires more skill to do; change a medication to one that needs to be compounded as that too requires more skill. My mom has Lewy Body Dementia and she is still pretty good on her ADL's even to this day so the other medical was more about monitoring for items that are "significant" - the day my mom hit a 10% weight loss and a critical H&H, the doc wrote out the orders for NH needed. Took about 6 months to create the file. I bet you are horrified at them doing another 6 months..... but since she is blind, you can probably get alot more done sooner as being blind has it's own special circumstances. My MIL was legally blind and got moved to the top of the list for stuff because of it. Now being blind has it's challenges as some NH want not too many blind because of the extra staffing needed. If you have a Lighthouse for the Blind in you area, contact them to speak with a counselor or a social worker to see which NH are more "user friendly".

You can apply for Medicaid on your own. BUT if this is about getting them into a NH, then the NH will do the intake for the application. My mom's NH had a 1 page list of items they required and they reviewed (my MIL was 2 pages and they both were in TX - go figure). In turn all this was sent to the Medicaid caseworker assigned to that NH along with the NH bill to Medicaid. My mom's application was slightly over 100 pages (mainly due to old-school style legal size insurance policies) and took about 5 months to clear. It was a 3 year and 6 month loud-back on her financials. I do an annual recertifiction (this is in TX) with financial documentation too but this is just the last 4 months of bank statements and yet another short form relishing her assets, insurance, etc and a MERP form. I'd suggest you keep everything in a blinder and easily accessible from here on out.

If you all don't have a group of NH in mind. Well it's field trip time. Just go to the ones which have Medicaid beds and will take her MEDICAID PENDING. IF they don't do Medicaid, don't waste your time looking. My experience is that if the facility has AL and NH, they will promote them moving into AL (which is usually private pay and may lure you that mom could get a Medicaid waiver for AL - yes there are waivers but not always available). You want a NH. The mediciaid pending is central to all this as she (which means the kids) will not have to private pay for the period of time in which her application is being processed.
WHatever you do, DO NOT let them sign off on the application or any of the forms with their own signature: either have mom sign herself in or they sign each and every signature as "Jane Jones in her capacity as DPOA for Marie Smith". The attorney will know how it needs to read best for your state. Then speak with the social worker (not admissions) regarding their approach to her blindness. I've found the social workers are a font of good information and as most states require them to be on staff, they can be alot more honest about stuff than admissions (often they are all about selling.)

The rural property may be an issue for Medicaid. Their homestead is an exempt "asset" but land or other property usually is not. Plus the complication of tenant-in-common. Since sissy is also blind, she will have an exemption from MERP
(estate recovery after death) on the property if she outlives your son's MIL. But if she dies, then your MIL (I'm guessing) inheirits the property - which may become an asset. This is totally sticky and you should get legal on it before you do the application. They may want to have a codicil done to their wills to better plan on what happens to the property when they die and how to deal with it best so no fallout from Medicaid.

Each state administer's their Medicaid program under federal guidelines. So the "income" amounts OK for Medicaid varies. You need to find out what it is. Most states have it at $ 2,020.00 but like TX is $ 2,094.00. This should be on your state's Health and Human Serviceswebsite Elderly section. If all she get's is SS and it's probably way under 2K, then she is good for "income" for Medicaid.

Good luck and keep a sense of humor, you'll need it.
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