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She started on the third day wanting to go home. She has a mild cognitive disorder and doesn't understand that there's more to her therapy than walking to the nurse's station and back. We keep telling her it's up to the doctor/staff when she will be released, but she doesn't believe us. Now she's on day 20, and they are saying they are concerned about her safety living alone so they want to keep her a while longer. She can't qualify for Medicaid to pay for AL due to slightly exceeding the income limit. She asks daily if she is going home today, and the staff is so vague and won't give us any kind of timeline. Do I keep her there being miserable but safe, or take her out against medical advice where she may be unsafe at home but happy? I can only afford someone to look in on her for about 10 hours a week. Family visits on the weekend.

Your mom has more than 'a mild cognitive disorder' at play if she doesn't understand what's going on and keeps repeating the same questions over & over again since day 3 of rehab! That said, it's not safe for her to live alone with only 10 hours a week of care and family visits during the weekend, based JUST on the cognitive issues alone. You have to consider that the SNF may want to keep her for a valid reason, in their long term care section. If she 'slightly exceeds the income limit', you need to talk to a Medicaid attorney (Elder Care) to see if that excess income can be put into a Miller Trust so she CAN qualify for long term care under Medicaid. This needs to be about safety now and not mom being 'happy' at home alone. She needs more care than she'll get at home, and unless you can arrange that, she needs to stay put where she's at. Mom should be paying for ALL of her care, whether it's in home or in a facility.

My father faced the exact same situation when he was in rehab back in 2014, so I had a choice as to whether to place him (and mom) in Assisted Living or leave him in the long term care section of the SNF he was in for rehab. I chose Assisted Living and had to hustle to move them out of Independent Living and into AL together. Safety is the #1 goal with elderly parents.

Good luck.
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Reply to lealonnie1
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Please look into whether a Miller Trust is available in your state. It’s a way to deal with extra income so that a person can qualify for Medicaid.

ETA that Lealonnie1 beat me to it, with additional great info as well. 😊
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Reply to SnoopyLove
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Safety first ALWAYS.

MOST newly placed residents, regardless of the type of facility, suffer difficult periods of adjustment when entering care.

Typically, we as caregivers suffer more than they do. I know that was the case when my LO entered her very nice MC.

After a few months, she loved the “hotel” where she was living.

Risking the damage that can occur from a fall risk is not worth putting an LO through the pain.
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Cover999 Sep 5, 2022
Medication probably helped as well.
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Getting the care she needs and her safety is the priority, not just how happy she is or isn't. And as others have said, if she does not understand her condition and the needed treatment, this may be more than just "a mild cognitive disorder." In time, a full work up of her cognitive status should be done (a geriatric psychiatrist, neurologist and maybe a psychologist would be involved). If she has dementia (regardless of the type) the cognitive decline will just continue. And as others have said, she may not qualify for Medicaid immediately but one can "spend down assets" over time to qualify.

Get with an Elder Care lawyer licensed in your state to work through this before making any concrete decisions. Hopefully you have a durable power of attorney so you can handle your mom's financial issues and spend her funds as needed for "HER care" and to spend down if needed. Ditto for an Advanced Directive to make medical decisions if needed or to serve as her "medical agent."

Her care team should really be given time to do a full assessment, physical and cognitive/mental status and determine her real condition and IF it is safe for her to be home. Can she live independently -- handle all activities of daily living/ADLs like toileting, bathing, dressing, managing her Rx w/out any help and feed herself and IADLs (instrumental activities of daily living -- driving, shopping for food, cooking, cleaning, doing laundry, making competent medical and financial decisions, etc)? If not, what level of help does she need: aid twice a week to help with bathing OR she can do it all on her one safely all the time?

BUT DO NOT discharge her against doctor's orders. If you do that, the insurance coverage for what has been provided thus far may be denied!

This happened to a cousin of mine. He broke his back, had surgery and was discharged from the hospital to a "rehab facility" post op because he was in no shape to go home and they wanted to teach him how to put on and take off his back brace (to be worn 24/7 for 8 weeks). How to move (no bending/twisting/lifting) etc. To do PT with him and to handle IV post op antibiotics and pain meds (back surgery is very painful). NOPE, cousin hated the rehab facility and 24 hours later called his father to come get him (cousin is 50, uncle is 81), probably the post op IV pain meds gave him the feeling he was OK. And his dumb father agreed to drive him hom. Cousin discharged himself against doctor's orders and went home with his dad. 2 days later, uncle had to call 911 as they had no hospital bed at home and no appropriate pain meds much less antibiotics. So while trying to sleep in a recliner (dumb, beyond dumb) the stitches broke open and he was in agony. 911 took cousin back to the hospital and a 2nd surgery had to happen as he was NOT wearing the required back brace had not been fitted yet for his (each is specially fitted based on size). And the wound was all infected too as there were no IV antibiotics "at home." TOTAL HOT MESS

INSURANCE said NOT covering as you discharged yourself against doctor's orders! You can imagine the bill....
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("Sigh"), I'm sorry, I'm tired of seeing "she can't qualify for Medicaid because of exceeding the limit". She needs to go on Nursing home Medicaid or LTC Medicaid. If she is a danger to herself at home and has trouble with ADL'S, she absolutely can qualify for LTC Medicaid. She will not be safe at home, so home is out of the question. The staff at the NH will realize this and cannot send her to an unsafe environment. Just keep telling her "Mom, you need to get a little stronger, keep doing what the nurse tells you to do". Do not take her out of there! You will be stuck and will soon be in over your head.
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If rehab is more than walking to the nursing station and back, then how is she going to get that therapy at home?

Do you actually plan on moving her home to live alone? SHE pays for the caregiver at home -- not you -- so can she afford that?

Rehab stinks. It stinks for everyone who goes to it, but it's something to get through while working as hard as possible for a successful discharge. Perhaps empathizing with Mom's misery and pointing out that she really does need to work hard to avoid having to return once she's sprung would have some effect. While she's still in there, you could be consulting an attorney who specializes in Medicaid to determine how to get Mom into care, because I have a feeling that's really where she's headed -- not home.
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Reply to MJ1929
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The Miller Trust in some States is called a Qualifying Income Trust (QIT). Not all States allow them. The amount over the income cap is put into the Trust. When the person passes, it reverts back to Medicaid.

Day 20 is the last day that Medicare will pay 100%. The 21st to the 100th day Medicare only pays 50%. The other 50% is paid by the patient or their secondary insurance fully or partially. When my Mom was in Rehab just to get her strength back I told them there was no money after the 20th day. Moms secondary did not cover the 50% balance. She was discharged on the 18th day. She had Dementia and all I heard from the therapist was she couldn't follow instructions or remember her exercises from day to day. Duh, she had Dementia.

Medicaid does not pay for AL. Unless your lucky to live it a State that does. In my State u need to pay privately for at least 2 years to have Medicaid pay.

While Mom is in Rehab have her evaluated for 24/7 care. She may not be able to be on her own anymore. She can go right from rehab to LTC or an AL.
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She's not ready to go home and even more so if she can't understand that.
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1. Yes you keep her safe. Think of a minor child who is miserable. Do you test letting a kid play in traffic and hope for the best?

2. You may have to get doctor help to get court approved guardianship status for your Mom so you make decisions when she is cognitively impaired.

3. If she has a driver's license and access to a credit card to discharge herself, get a ride home and drive or rent a car, you could have a bigger issue.

OR 4. she could rack up big shopping bills if mentally she isn't her better self.

Yes, always error toward safety and you can't end up with a criminal charge for elder abandonment or neglect.

5. Medicaid for home care has in home support services. It covers about 100 hours/ mo.

That is why you would have to find and hire outside help for remaining shifts 24/7. Going rate for experienced quality care average is $28/ hr on up.

With cognitive impairment she can wander and get lost. She may need to be locked in residence.

There is a national shortage of locked facilities assisted living. Start searching now and get her waitlisted.

With guardianship status you can choose an assisted living for a temp stay or long term permanent. Do look at several. Contact licensing and go review the "fines file." How many. how often and for what? Some are nuisance fines, like a paper was filed a day late. Forgive that. Look for notable safety issues.

You are in role reversal now. It is your turn to be the parent. If you have her move in with you, it may be difficult to later say "no, it is time to go to assisted living. I can't give up my career responsibilities to help you or I won't have my retirement for myself and my family. The impact on my marriage/ relationship or children would be too heavy. Instead of being the loving adult kid you spend quality time with, I would be the one frustrating you often in order to protect you. You will be happier in assisted living."

Assisted Livings accept Social Security and SSI, not Medicaid. Skilled Nursing, Nursing Homes and Hospice take Medicaid.

As for Medicaid asset limit... if Social Security is paid direct to assisted living, her income assets will be lower and she should qualify. What counts is what hits her bank account. OR set up a Miller's Trust aka Special Needs Trust and Trust account accepts all income, then pays her a small amount monthly for incidentals after assisted living is paid.

Try to avoid nursing homes. Most are not good. Usually are depressing places.

Board and Cares can be okay, but your mom will likely be kept more active at assisted living. Most have physical therapy and / or a gym. Some have pools.

Memory care will cost $5000-7000/ mo as of Aug 2022. Avoid consigning to pay financial commitments. Sign as Power of Atty or Guardian and write that after your name once you have that status. You don't want your own assets at risk of lien.

The Trust can also sign as it has same rights as a person. Then any authorized board member(s) - whatever the Bylaws say - can sign as the financial party.

See an eldercare lawyer for Legal Advice. I am not a lawyer. I consult on eldercare legislation.

If you send your mom home, she can easily fall multiple times and not call for help. Seniors often have medical alert buttons but won't use them because they are afraid it costs more money or they don't want to incur an ambulance cost or bother anyone.

Trust the doctor. Not interns. Interns can make dumb mistakes... like trying to release my 93 year old father from hospital, who was high on pain killers, and weak, to drive himself home from hospital- Friday night rush hour traffic - to make an hour freeway drive.

I called at the "right time " in the middle of this, ( I was west coast, he was eastern US), found out was happening. Reached Physical Therapy Director who said he hadn't released him! He would stop this immediately- and did - while I was on phone hearing him chew out the intern.

He did go home Saturday. Had many falls. Died next week.
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caroli1 Sep 5, 2022
As has been discussed here many times, Medicaid rarely pays for AL; if the person qualifies, Medicaid pays for NH. Dixiegirlnc, you wrote that your mother did not qualify for Medicaid for AL for income reasons, but if she qualified by income, it would almost certainly be for NH unless you are trying to get in-home care, for which the Medicaid qualification is different than for LTC. While she is in rehab, it's Medicare that's paying, as you know.
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Sign her out and get Medicare to come in twice a week for P/T. It sounds like the rehab facility is milking her insurance. I've heard too many stories about elderly getting 40 minutes of p/t while in rehab, and spending the rest of the day alone and neglected. She is just a number to them. Safe? People fall, get D-diff and worse in rehab all the time. The longer she is there, the more confused and agitated and less independent she will be. Get her out and do everything you can to keep her safe in her own home. btw, please go see a elder law attorney to get moms assets and health proxy in order and see what mom needs to do in order to qualify for AL care.
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Cover999 Sep 5, 2022
Exactly $$$
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