I am taking care of my mom in her home and living with her. Now they say she needs to be in SNF. What is my recourse?

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We cannot afford that and she does not want to sell her home. They have not let me work, because she cannot be alone for more than 1-2 hours so if we sell her home, I will also have nowhere to go. I have been taking care of her for 2 years and am her DPOA. Her insurance company is tired of paying hospital and SNF and is now trying to force her out by reporting me for financial fraud because I won’t sell the home per my mothers request not too. They also reported me for neglect because they say she needs 24/7 care due to an eating disorder and because I won’t put her in a home. She receives a pension but it is not enough to finance the type of care she needs according to her doctors. The home has very little equity as well and she is still paying the mortgage. So she would not benefit from this because it would not be enough to sustain her care. She is 83 and only slightly demented but when she’s at the hospital she’s out of her place and acts very demented. The insurance company first sent the Sheriff and then APS. I have been told by another social worker who sees this as unbelievable as well that they are trying to put a 3rd thing on with APS for lack of resources. This is ridiculous as I have my license’s in the medical field as well. What can I do? My mother does not want to go to a home and I don’t believe she is ready for one either. When I explained to her what her insurance was trying to do by forcing her to try and go over to medi-cal and let everything be absorbed, she became very depressed and is now back in the hospital, but insurance is tired of paying for her over and over due to her eating disorder. They say she needs psychiatric help but they refuse to pay for it. Just recently the doctor placed her in a psychiatric facility and now they have come after me because they are being forced to pay for it. I am being harassed almost every day by Social workers and case managers. What is my recourse? I am the only one that is caring for her and I have absolutely no family help because they are either far and elderly themselves.
This has been exhausting trying to put up with the harassment from her insurance company.
Thanks.

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Thank you! That gives me some hope. She is getting more depressed by the day being away from home and keeps asking about her kitty cat. I’m new to all of the long term care stuff and when the Sheriffs showed up and then APS I was broadsided. That’s still going on because they can’t physically speak to her because she’s not home and 3 hours away. Now they are telling me they aren’t letting her out until the investigations are finished. But I am told they can’t finish them until they speak with her first. It’s just like a viscous cycle round and round.
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I think I would check on that if I were you. California is more progressive than Colorado and in Colorado, if the person is not in the nursing home, Medicaid provides all kinds of in home care for not a penny. Mom gets a caregiver for 11 hours a day right now and maybe more if she needs it later. Mom keeps her SS and pension to use for her personal needs, ie rent, food, etc. She can't have more than $2000 in her account at any given time, though, so she can't really save the money, but it certainly helps to pay her day to day expenses, and she can buy some of the things that she wouldn't be able to if we had to use the money for caregivers.

Now if she were to go into a nursing home, then her SS and pension would go to the nursing home with only a small amount, like $50 for her personal needs. So please check that out. It may be a much better situation for you if you can get all that help she needs, but still have her SS and pension to pay the mortgage, etc. Good luck.
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In answer to the Medi-cal question, I was told by the social worker that will absorb her entire pension and she still has a mortgage, which would not allow her to pay that.
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It is a difficult situation and no I am not financially dependent on her. I helped pay for her bills for a couple of years prior to moving back in. I would have trouble paying for rent at the moment if we had to give up the house, but otherwise financially I am stable. Unfortunately yes, now I cannot work with her needs. She is mostly independent with slight dementia. It is the eating disorder that causes the problems. I am being instructed by her doctors to not put her in long term care just yet. It’s the insurance that does not want to deal with psychiatric issues that has caused this problem. Because now they are being forced to deal with it. 4 of her doctors have been pushing for this for 3 months.
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Lay this all out for the social worker.

It sounds as though your mother, due to her psychiatric issues, is no longer capable of "driving the bus". You are going to need to present things to her, as her DPOA, as "this is what needs to happen, per your doctors".

I'm sure the thought of being on Medi-cal has some "meaning" for your mom; that it's welfare, or that it means that she's a failure. People with chronic mental illness often have disordered ways of thinking, and I think it's best right now to shield your mom from things that are going to further depress her.

Make sure that YOU, as her DPOA, are looking at the facts and not misconceptions. A denial from an insurance company is sometimes a missing code, not someone "coming after you". Make sure that you are working with the medical professionals to get all of mom's treatments coded in such a way that they are paid for by insurance; don't take those insurance denials as final.

I went through this with my mentally ill, demented MIL; she saw a conspiracy at every turn. We just called up the insurance company and had the doctors resubmit bills and things got paid for.
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How many hospital admissions during the 2 years you have been caring for her?

It's not working, is it. Your living with your mother, caring for her 24/7, attempting to meet her needs, unable to work, financially dependent on her, left with nowhere to go and nowhere to live... it's not working. She isn't getting the treatment she needs and you are increasingly finding yourself in a total bind.

That sympathetic social worker sounds like a good resource for you. Maybe she can support you with finding a way forward? But things can't go on as they are. You'll feel a heck of a lot better once you just decide to face that head on.
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This sounds like a really terrible situation for you and your mother! My heart goes out to you.

Could you explain a little more about why you don't want Mom on medi-cal? It seems like that would provide some financial solutions and also get that insurance company out of the picture. Medicaid can provide in-home help as well as pay for a care center when that time comes. It would help us answering you if you can explain why you are avoiding that solution.
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