My understanding is that if the medical condition can be totally dealt with within “medication management” that does not meet the criteria of skilled nursing needed. Clearly ask her MD if this is her situation- I’m going to guess it is.

To get into a NH & onto LTC Medicaid they have to show to be at need for skilled nursing care in a facility. She’s imo going to need more health care issues into her chart other than schizophrenia. The place she is in now, are there Medicaid beds? & if so will they segueway her from private pay to Medicaid? And will the MDs/ medical director actively build her chart to show need?

If not, she’s gonna need to move and it’s good you are being proactive in this now. I moved my mom from IL to a NH totally bypassing the AL phase. Her gerontologist saw her every 4-5 weeks for about 6 mos and was proactive in denoting her health changes and doing lab work. The visit she had a 10% weight loss, a bad H&H lab report and few other things (like switch from Exelon pill to patch which requires “skill” to apply as she physically couldn’t), he wrote orders for skilled nursing needed and I moved her into a NH shortly thereafter.

A gerontologist who is also a medical director of a NH will know what criteria Medicaid looks at for skilled. I’d be concerned that if where your mom is is more of a behavioral care facility, it’s all about medication management & she’s good on her ADLs as long as she’s good on her drugs. They aren’t looking for other issues or co-morbidity diseases. You may need to take her to see a MD outside of the facility & one that takes Medicare. If you are anywhere by a medical school with a teaching hospital I’d suggest you get her an appointment with gerontology department there and then they can do whatever referrals needed. That’s the path we did for my mom at one of the University of TX Health Science Centers & all the gerontologists were medical directors of various NH in the area as it’s a part time position.
Good luck.
Helpful Answer (3)
Reply to igloo572
bd2018 Sep 13, 2018
Thank you! Yes we use the Health Science Center as well. I will set up a Gerontology appt. I also plan to see Todd Marquardt, Eldercare Atty. Thank you again!
How old is she? Does she qualify for disability?
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Reply to Sunnygirl1
bd2018 Sep 8, 2018
76 and that’s my question. Is schizophrenia induced dementia medically eligible for benefits

I don’t know how your Mom’s Schizophrenia diagnosis will play into her medical need requirement.

My Mom had Dementia and she fell a lot. I think the falling had something to do with her meeting the Medicaid Medical Need Requirement.

I am in Texas. Mom’s Primary Care Physician handled the paperwork stating she met the Medical Need Requirement. My Mom was in the NH 2012-2015. Rules, Regs, Requirements May have changed.

If Mom has funds for 1 more year of self pay in MC I think you are wise to explore your options now.

Moms funds can be used to secure a certified Elder Care Attorney to help get her Medicaid eligible.
Helpful Answer (1)
Reply to lizzywho61

She is 76 and also has dementia. She is cturrentlt in a memory care but being $4,0000 month and we can only afford it for 1 more year
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Reply to bd2018
MargaretMcKen Sep 7, 2018
In memory care, her schizophrenia drugs should be on track. You may need to focus on the dementia effects to 'justify' care. Good luck - it can't be easy!
Schizophrenia is usually managed reasonably well with drugs these days, although many people dislike the side effects and compliance is difficult to cope with. It also affects quite young people, and you don't say the age of the person you are asking about. I doubt if nursing home benefits would cover non-compliance, particularly for a younger person with many years ahead of them. They also have difficulties in fitting in to a facility which is dominated by very elderly people with dementia.
Helpful Answer (2)
Reply to MargaretMcKen

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