Mom's facility implemented a new contract and increased her cost of living which she cannot afford. What do I do?

Follow
Share

My 97 year old mom moved into an ACLF 2 years ago with a promise that she would get on the Medicaid Diversion program within 6 months. Obviously that did not happen. I finally got her on Medicaid by doing all the paper work. She still has not received any financial aid by means of Medicaid and now has a share of cost to meet. Her doctor visits are minimal so meeting the share of costs is impossible. She has acute lymphoma, COPD, obesity, incontinence, and needs help with her RDL services. A new contract for living at the facility which includes her level of care was signed in October, 2014. On April 14, 2014 a new care plan ( which did not change from the existing care plan) was initiated and she was given an increase in her cost of living by $500.00 without terminating the existing contract which doesn't expire until October 30, 2015. Eldercare can not help her. Medicaid cannot help her. She has no money to hire an attorney. Is there any service available to help her with this legal question without having to put out money up front. Must she pay the increase or can she get evicted?. Are there any services available for people of this age?

This question has been closed for answers. Ask a New Question.
Find Care & Housing
19

Answers

Show:
Thank you all for your wonderful replies, comments and suggestions. For those who don't live in Florida, I am finding that the system is not user friendly in Florida at all!. Example: Medicaid SOC is based on income. Social Security is an assets ( income) . She would have been better off had she never worked. Legal aid is also based on income. She would have to reach her SOC before Doctor bills, Dentist, or ambulance service can get paid. Obviously that is not going to happen as her health & well being are maintained on an even level.
It is not realistic to move her to another ACLF at this age. The next and last move would be to a NH but her mind is too good for that right now. She could be a counselor. She is not eligible for the Diversion program because she isn't "needy" enough! The ACLF gets paid by private parties (me) and her social security. Forget about extra money. ADL are just a must, diapers, support stockings, hair, reading material, etc! Before moving there, she was promised they would help get her on the Diversion Program. That never materialized and she was already moved and settled into this ACLF. The family is taking up the slack but definitely need financial aid before that runs out also. I have just submitted a new care plan and am also seeking legal assistance. We'll see.
Helpful Answer (0)
Report

Bea - I'm confused…..so mom is in a Adult Congregate Facility, correct?
And mom has qualified for Medicaid, correct? Now I'm assuming that the ACLF participates in your states Medicaid diversion program (so that their stay in a ACLF will be paid for by Medicaid). Is this the case?

Now I bet the problem is with how the ACLF does the diversion as the vast majority of the residents are all private pay and so the contracts sent out are all the same as they are private pay contracts. Most states do not even do a Medicaid diversion for paying any assisted living or congregate living, so the fact that your state does this is good. (Like for my mom in TX, it is much easier to get them into a NH and onto Medicaid, rather than have them be in AL and wait for the very, very limited slots on the diversion program.) The # of AL who even participate in diversion is teeny tiny too and they basically fill the diversion slots from within their established residents. I would suggest you get all of mom's Medicaid info - like her approval letter and the letter that details her co-pay (this is called the "SOC" share of cost in Medicaid-speak) and go to the business office. If the ACLF is still participating in diversion, then mom's payment responsibility is whatever is her "SOC". The SOC is all her total income each month less a smallish amount that is called her "personal needs / care allowance" and it runs somewhere between $ 35 - 90 a mo (your state sets the amount). Now I assume that mom has been regularly paying her SOC - this is mucho importante because if they don't the facility can terminate the contract for noncompliance. Is mom totally good on all her payments to the ACLF?

How does the ACLF get paid, you write them a check? or are they getting direct deposit of mom's income? - personally I would not ever do a direct deposit but instead write a check and then place a smallish sum (like $ 150) in the ACLF patient trust fund account so mom can draw from this for her beauty salon charges, or other small things she spends on. The facility cannot require that they get the monthly income checks directly either, so if they say that, they are incorrect. (The only time the facility can require direct deposit is if there is a Miller trust done and your state requires under Miller for them to get it)

Often a facility will do their own take on the SOC and look at a the overall monthly income without deducting the cost of Medicare payment taken from SS or any insurance or other fees automatically taken from a retirement or annuity. If they are used to all residents are private pay, the bookkeeper is not taking any of the Medicaid rules into account when they send out the contracts. So that each month, the NH "bill" is not getting paid. So look into those figures to make sure that is all correct.

Now if at some point it just seems that the facility is just not trying to work with you, it may be time to look for a NH for mom. Some facilities just find that participating in a diversion program just flat takes too much office time (like at my mom's NH they do NOT take any LTC insurance as the reporting requirements just need too much time to be worth the payment when they can easily fill the beds with private pay or Medicaid.) The one good thing about this is that a NH will take Medicaid and there is no contract that can vary or change. They get paid what the state has set as the state reimbursement rate; mom just pays her SOC & nothing extra. So think about if you need to come up with a list of NH that take Medicaid. You know if your first choice is full, and another NH will take her, you can move her to NH # 2 and then move her to your first choice once a bed opens up there. Moving them is a PIA but can be done and without any penalty under Medicaid rules. I did it with my mom and it was really not very disruptive in retrospect. Good luck and keep a sense of humor in all this!
Helpful Answer (1)
Report

Most of what people want is covered under Long Term Care, which you pay for separately. As a caregiver, you might consider getting it for yourself, from a company that will be around for a long long time. Probably too late for the ones you are caring for. It doesn't make much sense, I think that is why we assume this coverage is a normal part of health insurance since it is a normal part of aging, but noooooooo......
Helpful Answer (0)
Report

To my knowledge, Medicare does not pay for the cost of nursing homes or assisted living facilities. IF your loved one has been hospitalized and IF the doctor says he/she requires rehab, then they can go to a nursing home and Medicare will pay for 30 days of rehab. No more.
Helpful Answer (0)
Report

Laura, the elderly indigent here in Buffalo NY end up in the county infirmary. For a hundred years it was a building next to a prison farm complex. Recently a new facility was built next to Erie County Medical Center (ECMC).
Helpful Answer (0)
Report

This issue begs the question... Where are the elderly placed if they must have help due to illness or dementia and have no family or real income?
Helpful Answer (0)
Report

First like drbless, if they are getting snotty, see if you can dig up $500 to give you time.
Question 1. Why isn't Medicaid helping?

This sounds a bit odd. First, I am somewhat surprised that they would take her on "assisted living".

Every state has a legal aid society, contact them. Also most states have an elder Ombudsman program of sorts, Contact them. Other option might look for another facility. It could be in the contract that they can charge for additional services, if they are needed if beyond the stated level of care. The care home may well be within their rights, but I want an answer on the Medicaid. Medicare would pay for a modest time fallowing a discharge from a medical facility, but is not a long term solution.
I wish you luck.
Helpful Answer (0)
Report

Keep paying the amount for the old contract and before they can evict ya it would have to go to court anyway maybe a judge needs to look at what you'll have anyway. Sometimes places try to get over on the elderly and sick. But after you win she may be mistreated then you have to think if you want you mother there are not. Cruel world we live in.
Helpful Answer (0)
Report

It sound like no indication of old lease terminating and if it not in writing in the new lease then she under two different leases. Question is which lease is she to pay? both. You don't change in the mist of a contract they are bound for the period indicated unless the lease said that at anytime the lease can be revoked. Otherwise she can break it as well as they can.Legal Aid or maybe even fair housing since she lives there or State crimes against seniors
Helpful Answer (0)
Report

Check with the county your mother lives in. Homes are certified by the county usually. Let them know what is happening, and ask what needs to happen to get help. I think she will need a level of care evaluation, which the county probably does, and assistance in locating appropriate level of care housing, which will be a nursing home (and or Adult Foster Care ACF). But do start with the county.
Helpful Answer (2)
Report

This question has been closed for answers. Ask a New Question.