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Idk this is appropriate forum. My MIL is 93 yrs old and in a nursing home. She would not consent to POA under any circumstances prior to NH admission. She has NPD and very borderline. My husband spoke with a. Elder Care attorney which just made things more confusing. He said the NH can become the legal guardian but it also is a conflict of interest. My MIL has a condo that's paid off and receives social security and retirement funds and also has money invested. How does the nursing home get paid? We were told her stay is covered for the first 120 days but what happens after that? Since there's nothing legal we can't liquidate her assets. Thanks.

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Its not 120 days. Its a total of a 100 days the first 20 paid 100% the next 80, 50% of the daily room cost. When you took her from one Rehab to another, those days do not start over. For example, if out of the first 20 days she did 15 with the old rehab, then she only has 5 of the first 20 left when she enters the new Rehab. On the 6th day in the new Rehab she will be required to pay 50% of the daily cost of a room because she met 15 days of the first 20 at the other Rehab. She only now has 80 days in the new Rehab and will be paying 50% of the daily cost. If she does not progress, she won't even have 80 days. Medicare will have her discharged.

If your MIL has no assets she will need to apply for Medicaid. Her SS and any pension she receives will need to be used to offset her care. Medicaid will pay their share. Your husband does not have to chose that NH. He can place her anywhere there is a Medicaid bed available.
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Someone is going to have to obtain guardianship over her. If no one in the family wants to take on this responsibility, then someone must call APS and get the state to intervene. Exactly what Isthisreallyreal said. Her assets are going to need to be accessed to pay the Nursing Home, and when she runs out of money, Medicaid will need to be applied for.
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I would suggest that your husband applies for an emergency guardianship. If he does not want that responsibilty then he needs to let the state intervene, he would call APS and tell them the situation and they will start the ball rolling for that. From what you have shared, I would go the state route personally. She can deal with strangers and not use your hubby as her scratching post for the consequences she is and will be paying because of her choices.

I would NOT allow the nursing home to become her guardian, it's like having the fox guard the hen house, they are for profit and self serving, enough of a reason to stop that route. However, if that is who the state chooses, so be it.

EDIT: Your husband should refuse if he is asked to sign any paperwork by the facility or anyone that is not his representative, ie his attorney. They ALL have payment responsibilty somewhere in that 10 to 30 page contract they are asking to be signed and they will lie to his face about what it says. He does not want to be held responsible for the self pay of a NH for his mom.
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lavidaloca31 Feb 2, 2025
Thank you for your reply. My MIL doesn't have an APS caseworker. How does emergency guardianship work?
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Is your MIL in Rehab right now? If so Medicare pays for 20 days 100%. 21 to 100 50%. The other 50% is paid by MIL or her supplimental. Thise 100 days are not guarenteed. If MIL hits a plateau, she will be released from Rehab. If at that time you feel she needs more care than she can be placed in an appropriate facility. Assisted Livings and Memory cares are private pay. Long-term care facilities are too private pay unless she qualifies for Medicade.

With Medicade she pretty much can have no assets. Her condo is considered an exempt asset until death. Then its an asset that Medicaid can recover from the money they put out. MIL's SS and pension will be used for her care then Medicaid pays their portion. This means no money for the Condo's upkeep.

I would consult with an elder lawyer. Going to be hard to do anything for this woman without POA or Guardianship.
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lavidaloca31 Feb 2, 2025
She is in rehab in the NH. Idk if you saw my previous posts but she started in a rehab at another NH where staff felt she needed LTC. My husband was disgusted by some of the conditions there and took her out against medical advice. The 120 day thing was explained to him from the first NH. While in the rehab at current NH she suffered a bad fall and was taken to the ER. At the hospital they discovered an aneurysm in her lumbar spine over 7mm. The hosp chose not to operate because of her age. She needs 24/7 care.
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If she is paying then someone is writing the check or authorizing withdrawal by the nursing home. Her stay is "covered" you are told?
Then she is in Rehab or SNF I think you are saying? I don't know what an ordinary Nursing Home means by her being covered for 120 days.
I am sorry the attorney was confusing. But this is a simple matter of who, what and when in terms of coverage. I would see their admins and social workers to work out who currently is listed as acting for Mom.

Insurance, unless long term care insurance doesn't cover Nursing homes. Resident are usually self pay if there are assets.

Your Mom, for all care and so long as she has liquid assets other (other than one home and one car), would be self pay until she has spent down to an amount dictated and proscribed by your State. Nursing Homes getting paid SOME way for sure. They themselves are not allowed to be guardian. Is there a family member currently acting as POA?
After all assets are gone she would apply for Medicaid according to rules of your State. Check Medicaid site for information.
If Mom is in nursing home then someone is acting for her if she cannot act herself. Whether that is a POA or conservator or guardian, someone has the reins here. Check with your nursing home to find out who signed on the admission as POA or next of kin.

I am wishing you good luck. With the pension and such this will get complicated fast. I would see an elder law attorney.
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lavidaloca31 Feb 2, 2025
HI Alva Deer,
She has both medicaid and Medicare. No one is writing any checks. She was in rehab of NH. Recently she fell and was taken to ER. At the ER it was discovered that she has a lumbar spine aneurysm over 7mm. They chose not to operate due to her age. My husband went to the hosp and she didn't know who he was. She's been having conversations with her sister who passed about a year ago. She was discharged and sent back to rehab at NH. My husband has been signing paperwork as next of kin. She has no one else. She's burned bridges with family and friends.
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