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My mom has no money except SS. She was in a county subsidized adult group home. She began to decline and was hospitalized twice recently. Both times a doctor at the hospital asked if I had considered hospice for her. They believed she was not going get better and would continue to need hospitalizations for recurring UTI’s, dehydration, etc. The home said they would not take her back unless I paid for 8 hours of additional care per day—not possible. So the hospital found nursing homes. I approved of one and she was sent there—Medicaid pending. I just got a letter of denial. The caseworker hasn’t called back yet. Is this a common thing? Would they kick a 90year old with dementia who can’t get out of bed on her own out of the nursing home?? I can’t imagine it would be good for her to return to a group home. She has improved since leaving there, so she was not getting the best care. Should I bow out and let the nursing home battle with Medicaid? I am not her guardian and will not take any legal or financial responsibility. I am so done with all of this. I was never even close to my mom, but have taken responsibility for her care for the last seven years.

Thank, everyone, for your advice. I spoke to the financial person at the nursing home today. She said it is likely that a form (#257) had not been filed. She gave me info on who to speak with and how to file. Waiting to hear back.
She assured me I need not panic. 🤞
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Reply to Steppedup
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mstrbill Nov 4, 2020
Good to hear! Please keep us updated.
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This is a growing issue - elders who need help with ADL's and/or have dementia, but do not actually need skilled nursing care. How does this work out in terms of getting an elder care? Curious to hear posters opinions/experiences on this issue.
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Reply to rovana
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mstrbill Oct 31, 2020
Basically I think if there no one available to care for the elder in a home setting than a facility becomes the only option. My father probably could have remained at home if there were someone able to be with him 24/7. I couldn't as I had to work, and I had no one else to help me.
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Who did the filing? I hope you and not the NH. I am bad, I don't trust others to do their jobs so I do it.

When the caseworker calls, ask what they based their decision on. Maybe there is information missing. Just the Dementia and needing 24/7care should get her Medicaid.
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Reply to JoAnn29
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Please consult an elder care lawyer. In my state Medicaid can actually pay a family member to be a caregiver! I think that is an illegal requirement but please get legal advice
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Reply to KathleenQ
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Appeal the decision.
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Reply to Sendhelp
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I'd like to know how they came to that conclusion that she doesn't meet the requirement for long term care, perhaps it can be appealed. It just doesn't sound right or make sense. Does she need 24 hour supervision? If she has dementia, than she would and would qualify for Long term care. You can appeal if you wish, or leave it to the nursing home. You can ask the Physicians who were immediately involved with her if she meets NH standards and why Medicaid would deny her and if they could help with an appeal. Hopefully you signed the admission paperwork correctly at the NH so that they can not go after you personally for payment. As others have said, you must be strong with the NH. Do not let them coerce you into taking her home and make sure if they do discharge her, it is to a safe environment.(That may be the hospital, which they will do to get her off their hands and then she becomes the hospital's case).
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Reply to mstrbill
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It sounds like there was an error on the application.

ASK whomever is dealing with the medical information to help you ensure that her actual care level reflects on the application.
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Reply to Isthisrealyreal
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Without POA or guardianship I don't see how you CAN address this honestly.
Are you her health care POA? Do you know why she was denied medical? There is some information missing in all this. Just don't take her home, and keep working with medicaid and Social Workers. Where is she now. Is she in a nursing home now? Just know they cannot turn her out into the street until this is worked out. They may just need more MD paperwork to "qualify her". Let the Social Worker there handle it.
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Reply to AlvaDeer
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Steppedup Oct 30, 2020
I do have medical and financial POA. I was told there is skilled nursing (she doesn’t require that) and Long term care—and that was what she was trying to qualify for. She needs more attention than a group home can provide, but not skilled care. I just don’t understand the reason for the denial. Hopefully will hear something on Monday.
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It sounds to ne as though Medicaid thinks she is not "medically eligible" for NH care. Do they have her complete medical file?

This is not about needing help with ADLs; it is about needing skilled nursing care.

Do not agree to take her home or pay for anything. Stand firm and if they say "the state will take guardianship" say "yes, please".
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Reply to BarbBrooklyn
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