What can I do with my Mom (82) that needs 24hr care and doesnt qualify for Medicare? - AgingCare.com

What can I do with my Mom (82) that needs 24hr care and doesnt qualify for Medicare?

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And can't afford private pay nursing care.

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It's important that you understand the difference between MediCARE & MedicAID.

Medicare is a general entitlement program run by the feds. By & large Medicare is for hospitalization, doc & health professional bills, med's and will pay for short term "rehab" stay at a NH/rehab facility after 3+ hospital stay. Medicare is for short term limited situations. Everybody (almost) qualifies for Medicare as we pay into it via FICA when we are working or from our SS once retired. You sign up once 65.

MedicAID is a "needs-based" entitlement program. It is MedicAID which will pay for long term care needs - could be @ a NH or could be a community based program which provides for some type of at home services. Medicaid is run by each state with it's own rules but under an overall federal umbrella. For Medicaid you have to provide documentation of "need" - both financial need & medical need. By & large that means they cannot have nonexempt assets over 2K and a monthly income of over 2K and they also must qualify to be medically "needing" the care they are applying for. For Medicaid for NH, they have to be able to show the need for "skilled nursing services" and that usually requires doctors orders for admission if they are coming from living @ home along with a fat medical file to support the need for skilled nursing in a facility. Most NH admissions come from a hospital discharge, so the need for skilled nursing is established.

So what could be keeping her from qualifying for Medicaid?
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You personally don't have to be able to afford private-pay. Your mother does. And if she has too much income/assets to qualify for Medicaid, that money should be used for private pay, as long as it lasts. Then she will be qualified for Medicaid.

How do you know that she has too much income/assets? Have you spoken to someone knowledgeable?

Another way to use up her "excess" money is to buy things for her care. Would she benefit from a special wheel chair? Does she need a new wardrobe? Once she is on Medicaid she will have a fairly small allowance for personal needs. Get a few paid of shoes now, several sweaters, etc. She can spend that money on nearly anything for herself, but she cannot give it away.

Can you give us more particulars about how you know she doesn't qualify?
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Get her into a facility. Medicare will pay up to a point and during that time you apply for Medicaid on your mom's behalf (you'll have to have POA). Once your mom is approved for Medicaid (which can take several months, maybe longer) Medicaid foots the bill for the nursing home.

My dad's Medicare lapsed while he was in the NH but because I was in the middle of getting him approved for Medicaid he was able to stay.

It is a lot easier to do if your mom has to be hospitalized first. At the hospital you have access to social workers and people who can steer you in the right directions. They will also find a facility for your mom (you can ask about a preferred facility) and get her placed. It's a lot easier having someone do all of this footwork for you but not necessary. Do some research and find several facilities that you like. Talk to each one in person and make a decision and then let them help you fine-tune all the finances and details.

If your mom needs around-the-clock care and you can't afford in-home care around the clock a facility is your only option.
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You find a facility that will take her as a private pay patient. You talk to their intake people, they will figure out how much she has in the way of assets and how long she will be private pay. they will assist you with applying for Medicaid. Post back! This is such hard sutff! Easier if she's in the hospital or rehab, but not impossible if she's at home.
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Lynn, why doesn't your mother qualify for Medicaid? What assets does she currently have - a house, savings?
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Thank you for you answer pstegman. I wish it was this easy! Really at a loss!
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I wish this was an option!!! I can't afford private care.
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She spends her money until she does qualify for Medicaid. You are actually better off to go in on private pay for two years. If she gave money to family, they need to pay it back.
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I'm really at a loss!
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