Follow
Share

Mom is currently in a nursing home and only on Medicare. We would like to bring her home with us, but monthly income is $2584. I know a Miller trust would work if she stayed in the nursing home, but is there a way to achieve the same thing with in home care?

This question has been closed for answers. Ask a New Question.
Find Care & Housing
MA also has a Self Directed Care program. Contact can be made by locating your local Area Service Access Point on 800AgeInfo.
Helpful Answer (0)
Report

WizerOne, in NY State there is no required training, just an annual physical and updated shots. That is great for me but I find a lot of home health aides are untrained which makes hiring and training a bit challenging. Again, that is NY State. Other states may be different.
Helpful Answer (0)
Report

Ok Lassie, I got my notes out and here is a brief explanation. NY State calls the program CDPAP which stands for Consumer Directed Personal Assistance Program. It does exist in other states but not all states. Each state calls it something different of course. It is a Medicaid program to provide alternative ways of receiving home care services. The only family member they will not pay is a spouse if I remember correctly. You have to be on Medicaid, then you go thru the evaluation and they determine the number of hours required. Mom cannot do anything on her own. Even though the care manager prepared me for maybe 60-70 hours, she said she has never seen 24/7 given at the first evaluation. Then you have to use an approved agency to hire aides but I have full control over hiring, training and firing the aides. The agency takes care of payroll, HR, and such. It's a beautiful program, not without on going evaluations, paperwork, finding good help, etc, etc. But it was a lifesaver for me because I was drowning because no family will help. I hope that helps. If I can help anyone more, let me know.
Helpful Answer (1)
Report

Home care is being phased in, because it's much cheaper than a nursing home! Also I believe you would have to become certified to get paid for taking care of someone at home.
Helpful Answer (0)
Report

I am astonished to read above that 'Medicaid in NYS pays for 24/7 home care due to dementia. AND pays the offspring for the care, too.' Wow. What color is the sky in that part of the world??? And what is the name of this marvelous program? ....Too late for my concerns, but there are others reading here who would LOVE to know how to get 24/7 in-home care for their demented mom and also get paid themselves. I was told in no uncertain terms about 3-4 years ago in-home care was being phased out and all that Medicaid would pay for outside of a nursing home was a few hours a week for a senior day-care center.
Helpful Answer (0)
Report

Colene, I only learned about this "split off" of palliative care earlier this year. I haven't done much background research on it, but clearly need to as I'm finding a range of options offered by companies providing it.

I had thought after speaking with one of our very competent and supportive doctors that palliative care arranged for the home care, including a visiting physician and the health care team, and that home therapy could be provided, potential hospitalizations could be avoided by early detection and treated w/o hospitalization.

In talking with different companies to decide on one, I learned that (a) some ONLY provide consulting services but that (b) the family's PCP or other doctor scripts for the home care. Palliative care provides an assessment and "care plan", for which I'm sure they bill Medicare as well as ongoing "updates" on the care plan and care delivered thereunder.

Another company affiliates with a private group of doctors, who script for the home care. This essentially takes the monitoring away from an individual's own doctor or specialist and substitutes a doctor (s) and care team with which the individual may not be familiar or have any experience.

Yet another company only offers telephone support on a monthly basis.

Apparently companies are in various stages of either adapting or gearing up. One home care company I would like to provide palliative care as well told me that the staff have to be certified specifically for palliative care, so it's another level of applying to Medicare for certification, or whatever it's called that qualifies them to provide palliative care.

To me that suggests that Medicare establishes the standards.

At this point, I 'm not even sure home care is a "palliative option" that would work for us. But I think companies know that it makes sense to provide a continuum of care from palliative through hospice.

Three companies I researched do provide hospice and palliative care. One even has a program manager just for palliative care. It does make sense that the two services are linked because palliative can easily end up being hospice care, eventually.

I'm not really qualified to address hospice guidelines though, as I haven't focused or done that much research on it. And in our situation, I don't think it'll be necessary for a while, hopefully a long while!

The only standard I know of for palliative care though is that the individual has a chronic condition, but is not close to the dying stage. From there, it seems to change depending on which company provides what specific level of care and what either a treating physician or a palliative care company physician makes the assessment and scripts if appropriate. Seems to be that doesn't offer as much as an individual's treating physician would offer if he/she scripted for palliative care.

The representative of the home health care company applying for certification inferred that Medicare set the standards. I'd have to check my notes for sure, but that's my recollection.

Sorry I can't be more specific; clearly I need to learn more about palliative care before deciding it's worthwhile. What I don't want is a totally new doctor and home care group starting; I want a tried and true company with a track record.

Not sure I've answered your question; if not, please let me know. Sometimes I drift away from the topic!
Helpful Answer (1)
Report

The laws are different in each state, and it would also appear that some services are also different based on county. Hospice in my county will not come in until mom is determined to be within 6 months of dying. I also looked into Palliative care but it was pretty limited and only covered a few months thru Medicare. Medicare basically doesn't cover a whole lot.
So, with that said, I have mom at home with me. I had to set up a trust account (in some areas I think Miller trust is the same thing) because her $2,400 was over the allowed $845. So the overage goes into the trust and pays bills and pays me rent because she lives with me. New York State has a program that keeps people in their homes and out of nursing homes but you do have to be on Medicaid to qualify for that. It was thru that service that I was awarded 24/7 home care due to mom having dementia. That gives me the ability to have someone at the house 24/7. Now, this program also allows myself to get paid for the hours that I am caring for her. So, I know not all states have this program so you would have to look into it for your state. In most states, there is a way to make it happen so that she can stay home or live with you or another family member. My mom didn't have any assets (no home, no car, no savings, but she did have a trust which was set up to protect the commercial assets which Medicaid cannot touch what is in that trust). I did hire a Medicaid attorney and a privately paid care manager to get all of this in place. But it was well worth the frustration and money. Mom is happy being home with me, and I have help which is so very much appreciated. Don't ever give up. Keep making phone calls and asking questions. You will get will you want to be with your mom eventually. Good luck and take care of yourself!! :)
Helpful Answer (0)
Report

Hope you are spending your $$$ wisely and going to an attorney expert in Medicaid issues. Too often (but of course not always) "someone" or some "place" says the person cannot manage at home, and my personal bias is to think this is more often to gain another resident rather than in the person's best interest. Perhaps with adequate in-home assistance the person could be home. Just a thought.
Helpful Answer (0)
Report

Depends on your state. My mom received 1000 month , only on medicare. She had alzheimers and I took care of her for four years absolutely alone. She had frequent uti's , upper resp infections, frequent falls etc. I finally got hospice here 7 days before she passed from stroke
Helpful Answer (1)
Report

Dear Garden Artist,
What year did Palliative Care become a Hospice option?
I am just curious. Does Hospice use same guidelines nationally or can each state make decisions?
Thank you.

Your msg:
"The other option is Palliative Care, recently "split" off from hospice and now a separate program, paid for by Medicare. Conditions are still treated, but the focus would be to catch them (such as pneumonia) as early as possible, get antibiotics scripted for by the PC doctor, and treat at home.

People with "chronic conditions", such as COPD, and I believe diabetes, are eligible for Palliative Care. "
Helpful Answer (0)
Report

Thank you all, She was put in a nursing home originally for rehab and it was then determined she could not go home (to her home). Her options are a nursing home or move in with one of her children. She has been in the Nursing home long enough now that it is now private pay. She is now on dialysis as well as being diabetic and obese. I am contacting an attorney today to find out our options. Thanks again for all your info.
Helpful Answer (2)
Report

Sorry, I meant Medicaid.
Helpful Answer (0)
Report

Lars, what kind and what level of care do you think your mother needs? Is diabetic care the primary condition?

You do have two options, if you want home care, but it depends on whether you want medical home care or ADL and light housekeeping, etc. care.

First, why is she in a nursing home, and is it a rehab facility? How long has she been there? For what condition is she being treated? Have you discussed discharge and home care with the therapists and social workers?

Assuming she could be cared for at home, a NH doctor could script for home care, which would include nursing, PT, OT, speech therapy if necessary, a social worker and a home aid for bathing assistance (if you want that). Generally this lasts about a month, although I've been told that a treating physician can certify for further care. Medicare does pay for it.

If you need assistance with ADLs, you'd want private duty care. In my area it runs from about $19 to $26/hour. Depending on how much you need, you could get some care this way. It's all private pay though.

The other option is Palliative Care, recently "split" off from hospice and now a separate program, paid for by Medicare. Conditions are still treated, but the focus would be to catch them (such as pneumonia) as early as possible, get antibiotics scripted for by the PC doctor, and treat at home.

People with "chronic conditions", such as COPD, and I believe diabetes, are eligible for Palliative Care.

We're in the process of getting this, and I'm looking forward to having a nurse a few times a month to check for conditions that I couldn't DX myself.
Helpful Answer (3)
Report

Is she paying privately or in there for rehab? For rehab Medicare only pays 20days fully. After thatvthe 21 to the 100 they only pick up 50percent. Supplimentals pick up some. After 100 days its private pay.

You really need to run this by Medicare. Each state and each persons assets are different. The Social Worker at the facility may be able to help.
Helpful Answer (1)
Report

This question has been closed for answers. Ask a New Question.