How to continue to get the skilled nursing a loved one needs when insurance won't cover it?

Rehab is short term. She now needs placement in a SNF for long term care. I don't understand your statement about Medicaid being "a bandaid for a short amount of time. " Once she's approved for long term care (not rehab) in a SNF, that coverage lasts for life.

In terms of further rehab, she may have progressed as far as she's capable of progressing after such a serious stroke. If so look into a hospice evaluation for her now so she can be kept comfortable and not forced to do pt she's no longer capable of doing.

I'm sorry you're both faced with such a situation. Sending you a hug and a prayer that you get all the facts laid out for you with moms prognosis so a good decision can be made.

My mom is 70 and in a very similar situation to your mom. She went to rehab in December and in January they said she was making no progress and needed long term care, so she is now in skilled nursing. She has some savings but not enough to pay for more than a few months, so we are currently spending down her assets and selling her house so she can apply for Medicaid. This will cover her for as long as she will be in a snf, which at this point looks like the rest of her life.
I'm so sorry you are going through this. It is so hard to see someone you love go through this especially when they are younger. I wish you the best.

Dont believe everything these facilities say. Yes, the first 3 months after a stroke are where you see the fastest recovery, however, stroke recovery isn't linear and it takes time (people revoer even 5 years later). Medical/Medicaid LTC waiver is what you apply for and it'll pick up the board and care at a SNF facility. You mom will still have Medicare Part A which pays for her nursing and therapy needs. She is still a candidate for therapy if you can have the doctor write a referral noting she needs therapy for quality of life purposes. If not, there is always hospice (no this doesn't mean end of life) but the service will kick in and be paid for by Medicare where they'll send someone to come help take care of your moms basic needs (bathing, incontinence, etc).

Im 2 years into my mom suffering a severe stroke at 75 and to be honest, over seen more recovery in the past 6 months than I've seen before. I brought my mom home after 6 months in facilities in 2021. I couldn't take the lack of care from a SNF any longer. It's a LOT of work but I'm thankful for my 2 siblings who are in this with me together. I also work from home and grateful my job allows me to do this.

I think it depends on your situation. If you have the expendable time, then think about bringing her home. There is also LTC now offered at home via MediCal/Medicaid. It's another waiver you fill out but it allows your LO to be home with you and have the same care as if she were in a snf.

In addition to Glads post, the 100 days are not guaranteed. The days in Rehab depend on how the person progresses. If they hit a plateau they are discharged. If 24/7 care then they need to go to Long-term care if no one can care for them. If no assets, Medicaid is applied for to help pay for the persons care if they receive Medicaid, its for life.

My dad had a stroke. He went to an acute rehab. After a month and a half the rehab (pd by Medicare) discharged him home. The rehab helped him set up a live in aide, which he pd for out of pocket.

The aide was awful (just his scenario). He recently moved himself and my mom into a nursing home that he pays for out of pocket. It costs less to live at the nursing home than to have the live in aide.


Before the move to the nursing home...
From the case worker at the hospital I was able to get palliative care for mom and dad. Palliative care (different than visiting nurses), pd for by Medicare as a medical charge will come once a month. A social worker and a nurse, one time each per month. They have great information, they were even able to call my mom's primary Dr to get a script for mom's pt. They also helped get my dad another stint down the road for more in facility rehab.

Talk to the case worker at the current rehab (if they won't help contact the hospital case worker) to set up pt, ot, a nurse (1x week), a shower aide once a week for showers (they can sometimes help with bedding changes and laundry into a washer) at home. This was pd by Medicare, but was temporary until they felt there was a plateau.

If your mom doesn't have a caretaker, make sure you tell the rehab case worker that they can't release her until this is set up. If you're not the caretaker, make sure you say that. They can't send a stroke survivor home that can't swallow or walk without a care plan. They harassed me to come in for family participation for my dad's pt...I refused. I wasn't going to be his caretaker.

Medicaid is for those with limited funds that meet a criteria. It shouldn't be a temporary bandaid unless your mother's financials improve above the medicaid criteria. Medicaid is different than Medicare.

She needs "care" but she doesn't need skilled nursing care or rehab because she has been diagnosed and prognosis that there is nothing left to "fix" here. This means long term care. Cooperate with the discharge planners for placement. Consider hospice and palliative care. Hospice will give you some (tho little) extra support for her. It seems you are being told that she is unlikely to recover from this. I am so terribly sorry because she is quite young in terms of today's longevity. I am sorry that she is without assets to support her better, but the awful truth is that at her young age they would run out quickly in even the best case moving forward. This is dreadful and you must just suffer for her.

Insurance ie Medicare, will only cover a set time frame, usually 100 days in rehab. The first 20 days are paid at 100%, the remaining 80 days there is only partial coverage. Then payment for long term care will be either by mom's assets or Medicaid. Does mom have a home? That can be sold to raise money to pay for her care.

Medicare will only continue to pay as long as mom is improving.

There is not enough information here about mom's finances and assets to be able to provide a better answer. If mom has pension, Social Security, home and any other assets are all part of the equation.

kmn726: I am unsure why you stated that "Medicaid .... will just be a bandaid." Medicaid will cover long term care when the individual does not possess the funds.

LTC Medicaid or NH Medicaid is what she needs, it won't be for a short period of time, it will be for life. The SNF will continue to work with her.

Not sure what you mean that Medicaid is a bandaid. If she is eligible for a Medicaid bed in a NH, it will be ongoing. She will have to spend down her bank accounts (and other assets outside of her personal home/residence, car, and maybe a few other things they don't count against her). There will be a form in the application packet and it will ask if she intends to return to her home. Saying yes (as she probably would because most people, no matter how bad, will say they want to return home) will exempt the house. If you sell the house, that money will have to go into a bank account at this point and be used to self pay for her care at the NH until she spends it down and becomes eligible for Medicaid bed funding.

If she has money, you'll need to use it for her 24 hour care if she's going home. Either way, you don't get Medicaid when you have money to pay.

If she's not on social security or Medicare right now, maybe you meant to say you were applying for Medicare. Different from Medicaid. And yes, Medicare has limited time they pay for rehab/NH care. So you would probably want to start the Medicaid application now, too. Just remember, all of her income and assets are considered for the Medicaid program.