Mom (94) in assisted living, totally broke, has social security and now Medicaid, totally bedridden, denied transfer to nursing home. What can I do?

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If they wont transfer her to long term nursing, put on hospice at assisted living, and only pays health care portion for assisted living...how does she pay for $2,000 rent for room. Assisted living says they will evict her if she doesn't pay. If a 94 year old, half blind, can't walk, has no money, goes to bathroom in pull-ups, can't hear, fell out of bed three times and sent to ER, all banged up and stitches, can't move neck and no rails allowed on bed in assisted living, Sunshine medicaid wont put her in long term nursing care.....huh....I'm not getting this? What can I do?

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My suggestion is that your mom needs to go into a NH that takes Medicaid and apply for Medicaid to pay for her stay @ the NH. If she has qualified for hospice, then I would suggest you clearly speak with the hospice provider as to how to proceed. The hospice provider should be a different entity than the AL she is in. Your mom's statement of services from CMS (Medicare) should show the details on the providers also. Speak with hospice and say that you believe that your mom needs to be evaluated for needing skilled nursing care in a NH/LTC type of facility & needs to be done ASAP. The medical director of the hospice group could be the key to getting all this done.

The hospice group will have other facilities that they go to. (For my mom (in a NH on Medicaid and also on hospice/Medicare benefit), her hospice group goes to at least a dz other NH in the city with some Medicaid accepting NH and some only private pay.) Then from the list of NH that hospice gives you, call them to see who has beds open AND that accept new residents "Medicaid Pending". If your mom is impoverished (which she very well could be after private paying for AL for a while), then she should be OK for qualifying financially for Medicaid. You are still going to have to do a Medicaid application for her and get her financials & other documents to accompany her application, but if she has been doing a spend-down to pay for the AL, I bet she should be OK for Medicaid. Whatever monthly income she gets, will need to be paid to the facility as her required Medicaid co-pay (or her "SOC"/share of cost is Medicaid speak) - probably much like she is paying her current AL her SS, retirement or other income.

Realize that all this is not a simple signature on transfer paperwork but rather a more detailed needs based assessment of her health & cognitive ability that needs to be done to clearly show the need for a higher level of care beyond AL for Medicaid to pay & for a NH to accept her. Where is her MD in all this? Does she have her own MD outside of the AL? Or is the medical director of the hospice, now her only doc? Whatever the case, a doc will have to write the orders that skilled nursing care is needed and her medical files will need to show the need for skilled for all this to work.

So what is the place like that she is in now? It is just AL? or is it a "tiered" facility that goes from IL to AL to NH and allows for hospice also? Does it accept Medicaid for room & board? Or does it just accept Medicare for health costs and all the R&B is private pay? If it is just AL (even if it has a lock-down memory unit), then it will not qualify for skilled nursing so the foot dragging you are getting is because they can't ever provide the higher level of care for her.

And try to keep in mind that Medicare & Medicaid are very different programs and deal with & pay for different services. Medicare pays for provider services for specific treatments and is NOT designed to pay for long term services. Medicaid for the elderly is first & foremost designed to pay for a NH stay. Now some states have Medicaid diversion programs in which some Medicaid funds for NH is moved to & available for community based programs (like within an AL or home-based services) but these tend to be few & far between with limited beds usually from a waiting list. The vast majority of AL is all private pay and often it is the profit-center for a facilities (so emphasis is placed on having residents in AL and private paying for AL). The reality is that the easiest way to get her taken care of is to have her qualify to be admitted to a NH that accepts Medicaid. Good luck.

BTW if the R&B at the AL is 2K a month, that is really inexpensive. Most AL run from 3 - 6 K a month; NH run 4 - 12K mo. Sometimes the Medicaid reimbursement rate to a NH can be less than the private pay AL rate.
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Actually, Hospice is a Medicare program and not a Medicaid program.
And nobody uses bedrails anymore, there is more risk than benefit.
So she she still pays the ALF as she did before, with SS and pension or savings. If she was the widow of a vet, you could try VA Aid & Attendance.
The facility is obliged to help you with financial aid applications.
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