My parents bought spectacular long-term-care policies in the 1990s. I had to invoke dad's policy when he went to a memory care facility because he qualified as having a "severe cognitive impairment" and the policy paid for 100% of his facility expenses for 3 years.
Mom went to an ALF almost 2 years ago, confused, wheelchair-bound, unable to walk and to perform many of her activities of daily living. After her living at the ALF for 4-5 months they put mom into daily physical therapy and (unfortunately) they built her up just enough that she can function with a walker and is now capable of bathing & dressing.
NOTE: She is a fall risk and is hospitalized about every 4-6 weeks with a fall & head injury, so my belief is that she needs "stand by assistance" and is not capable of living alone. She has horrible balance, confusion, etc. She was hospitalized less than 2 weeks ago. So far she has broken her hand, her back, her shoulder and her ribs, all as the result of falls in her home since she turned 70.
I am working on invoking the long-term care policy but the insurance agency has already hinted that she might be too "capable" of performing her ADLs. Sigh...so if the policy rejects her, she will probably run out of money in a year or two.
I am an only child, mom has no other family or friends. I am not able to take her in or care for her, and, I will absolutely refuse. She is only 80 and her mother lived to 96 (so you see my potential dilemma).
I never ever imagined we would have to go down the Medicaid path. But, if the policy will not kick in, and she has established residency at the ALF for like 2-3 years, will they kick her out???????? I haven't broached the subject with the facility yet, I can't even discuss this out loud.
We are in Florida if that makes a difference. If they stick me with her my life is over. She has royally screwed the last 10-12 years of my life and honestly when she was in the wheelchair I finally had some peace.
I wish I had some sound advice for you. However, I'm at my wits end about what to do with my own mom and thinking a good Elder Law attorney is going to be part of the answer. I don't have high hopes though.
The elder law attorney will be able to determine if her medical profile triggers the insurance company's obligation to provide the benefits set forth in the policy.
Medicaid is run individually by each state so FL will have different rules than other states. In MN where I live, facilities will have different numbers of Medicaid beds available (and they are almost always a shared room, that's why they are referred to as "beds" not "rooms").
I believe the Medicaid app in FL looks back 5 years on the finances of the applicant.
Facilites are not obligated to accept Medicaid/provide beds, so this question always has to be asked of any place before committing. Some states' Medicaid will cover some or all of AL and MC (I think Michigan does). So, you must be careful getting guidance on this forum since participants live globally. You should consider consulting with a Medicaid Planner.
She may only be one more fall away from NOT being able to do her ADLs.
This would likely NOT be an ALF, but you can certain speak with (and you SHOULD speak with) the facility to ask your questions. You needn't give a lot of information; you only are asking if they do accept medicaid payment in this particular facility.
Do know that most people do not have long term care insurance and most people cannot afford either in home care or ALF on their own savings. So Nursing Homes are often the final stop.
BUT the final stop is not your home and your life. Your Mom and Dad have had their lives. Your own life need not be sacrificed on some altar of care giving.
Wish you good luck. Taking this a day at a time for now, I hope.
Start by finding a CELA lawyer and pay for a consult about both the policy and Medicaid for AL.
They can't force you to do hands on care or have her live with you.
Did you sell her house; I can't recall?
What is a CELA lawyer?