My 82 year old mother had a catastrophic stroke 4 months ago which left her paralyzed, with a feeding tube and cognitive decline. Before the stroke, she was taking care of herself while we shared an apartment.
I am 48 years old with a terminal cancer diagnosis, am on dialysis three times a week and have limited mobility. I am her POA, only child as well as her only living relative.
She, unbeknownst to me, failed to keep important documentation such as bank records, medical records, retirement/SS records. It took me two months, after her stroke, just to find the POA, advanced directive, etc. for the SNF.
Because of this, I have been unable to file for Medicaid because I’ve no supporting documentation and I was told by SNF she would be denied Medicaid because small pension/SS payments put her over the income limit. SNF says a Qualified Income Trust is the only option. They gave me only two weeks to get it in place.
Not only am I completely ignorant of the process, I have been unable to find an attorney who does Medicaid, or a Medicaid planner, in my area to help in the allotted time given. I’ve called everyone and I either get no response or I’m told they do not do such work.
Because of her condition, we lost our apartment, leased vehicle and belongings. I have been homeless/relying on friends to help me get care for my own needs. I only receive a small Social Security disability income.
The SNF is going to start eviction process soon. Not only is it unsafe for her to return to a home that no longer exists, but she requires complete care. She cannot sit up on her own, toilet herself, walk, and will not accept that she will never eat again. She has already aspirated after eating another resident’s food she somehow got a hold of. She’s asked for the police and a psychiatrist.
When I visit all she will talk about is being suicidal. I am at a complete loss as to what to do and what will happen to me because I am incompetent myself to be her POA with what little information she left me.
I don’t really have a question, but I’m looking for some insight and appreciate anyone who reads this.
I mention this because LTC Medicaid eligibility is not a “do it once & done” situation. There will for sure be an annual recertification process which will want some of the initial items submitted PLUS current stuff (like that years SSA amount paid document) and her last 3-4 months of bank statements. The recertification is very timeline sensitive- like 14/21 days - from its being sent. State can also send letter of inquiry* on other items that peak interest which too have to be responded to quickly. So you have to have a real dedicated mailing address for you to get in a timely manner all correspondence from the State. The State does do email contact but it still uses snail mail for a lot of what is done as mail & faxes are “legal” while emails are not.
If you should not be able to deal with whatever the State wants asap, State will move her over to suspension/ineligibility list. When that happens, it’s not just you that gets the Notices but the NH gets this as well. It becomes panic and crisis for all concerned. If she became a ward of the state, the guardian would deal with all this. It allows for you to be the daughter without also having to also be the accountant, the paralegal, the detective, etc. Often for ward situations, the guardian deals with all the legal & $, while a family member deal with the day to day stuff. Like you would be the one to go to the regular every 90 days care plan meeting for your mom at the NH, you’d be the one to shop for moms clothing replacement and draw from her $75 a mo personal needs allowance that TX does for those on TX LTC Medicaid.
*a recheck to see if any real property sold or transferred was done @ Fair Market Value. It can be for 5 years back from date of application to LTC Medicaid. So applied this last month, that would mean April, 2020 till now.
* if your mom (or her deceased/ ex husband) has a common name, that seems to cause inquiry Notices as well.
Any letter sent out will have a tight deadline to get back to Medicaid & with whatever information or documentation they need. Once it’s past the deadline, it just gets super sticky to deal with.
I called APS and they got on it right away although they didn’t offer much help. They put me in touch with someone who could do a QIT but I’ve been unable to get a hold of him.
On the other hand, a friend of mine found an attorney who is basically doing the QIT for and extremely discounted cost and a new power of attorney is being appointed. We have the month to get it done before she is evicted. But help was found after many prayers. Thank you to everyone for your help. There might be a chance to save my mom. Please continue to keep us in your thoughts and prayers. I had nowhere to turn to and you all gave me hope. Thank you so much.
- 1st default for all is to get family/POA to move their elder to a family members home; the facility does discharge report and gives it to POA / family. It’s now 100% on family to do and find the whatever’s of what is written in the discharge orders. If there is an outstanding bill, facility will send out past due then eventually turn it over to collections.
HOWEVER
if family placement is not happening then what can happen gets interdependent on the type of facility and what it’s licensing is and what the health status is on this resident.
Heres why… Almost all NH/SNF accept MediCARE. It has a requirement that a discharge has to provide for a “continuity of care” which means the NH / SNF cannot evict them to the street. It has to be to family who then become responsible for their care plan OR if that doesn’t happen the NH/SNF have to send them to a place that has skilled nursing services available, so a continuity of care exists. So for a NH/SNF that usually means sending them to ER / ED; then when hospital calls the NH/SNF that their old resident is about 2 B discharged, the facility will refuse the return. Classic move is for NH to call EMS as a resident appears to have had a TIA (transient ischemic attack) which is very subjective in how they “present” (aka how they look) so in an abundance of caution & concern the resident is whisked off by EMS to a ER / ED; they get stabilized or get admitted; then when it’s time to leave ER / hospital, the hospital discharge planner calls old NH/SNF to coordinate the return, that NH/SNF refuses the return. They will have a CYA reason that is valid…. eg cannot meet the level of care or no bed hold* request done or bed hold* expired so there is no bed available. That planner is now on speed dial to contact any family to get down there & take home mom/dad/MeMaw, etc & ASAP. If that fails, the planner has to try to find another NH or get a chart review done to have them admitted or sent to a different type of facility (like an LTACH or a hospice wing).
BUT for those in AL or in most MC, there is no “continuity of care” requirement so can be evicted to the street. Now that’s bad optics, so they too will do the EMS 2 ER run. But if the resident seems to just be too too healthy looking to get this to happen, AL and MC can send them to a shelter. Like homeless shelter!
Yeah, it’s pretty horrifying but it’s a legit move BECAUSE if they are in an AL, or in a MC that is licensed as a AL, it means the resident is able to do their basic ADLs with perhaps a bit of help. They can do for themselves. Now IRL that may be totally inaccurate but if they are living in AL they technically are ADL OK. So can be sent to a shelter.
LSS it’s important that your elder is in a facility appropriate to type of care they truly need. Often families have elders in AL/MC as way le$$ cost$ than a SNF, but should something go super bad, the safeguards that SNF placement requires will not be there.
*bed holds are something that often POA & fam are unaware of. In theory, any exit by a resident - whether it’s away for a weekend for a Therapeutic Home Visit / THV or going to the hospital for care - should have their POA do a bed hold notification. If on LTC Medicaid, bed holds can be quite precise and if you go past what’s ok then you can become ineligible for staying on LTC Medicaid. Like in my State (Louisiana) if on LTC Medicaid, bed holds are 7 days hospitalization & 15 days THV. But TX has all LTC Medicaid recipient absences that are not THV considered a discharge; THV cannot exceed 3 sequential days but THV are unlimited. Being compliant for bed hold matters as facilities get paid a reduced % by LTC Medicaid during bed hold days.
I hate to lose my mother to the system; prided myself on being able to care for her before this disaster. But hands are tied and reality is neither of us can continue.
Thank you for your kindness. This is such a great resource forum with lots of kind people.
I’ll update as I go along.
You admit here to us that you are helpless and unable to understand or know what to do.
It is time to tell the discharge planners at the SNF that you cannot act as your mother's POA because you are to qualified to do so, and because you are ill.
Same day place a call to APS to tell them what you have told us. Tell them your mom is being evicted and is an elder at risk with nowhere to go and that you aren't qualified enough or well enough to act as her POA.
Do know that while this SNF can bring in the state to take guardianship of mom (which they SHOULD DO) they cannot put her out in the streets unsafely. Let them know that you are not qualified and they must contact the state for guardianship.
Thinking of you and please keep us posted if you can.
I think you need to talk to the lawyer that did the documents for you to be POA and tell them that you can no longer be her POA, you are unable to fulfill the requirements due to YOUR health. Ask that the Court appoint a Guardian that can make decisions for mom.
You might even contact your local Senior Service Center and ask if they have a Social Worker that you can talk to that can help get this going.
OR
Go to the Court House and ask if there are any lawyers you might be able to talk to. (there is usually a Law Library that has paralegals that might help.)
As to the facility where mom is.
They can not discharge her unless there is a safe place she can go. Since you have no residence now they can not discharge her to you. Not to mention you probably are not physically able to care for her. If they do discharge her it would be to the hospital for some "reason" and then the hospital would be responsible for her discharge...sounds like a merry-go-round!
Have you asked the facility's social worker to help you with all this? And if you are not capable of being your moms POA(which it sounds like you aren't)then I would just call APS(Adult Protective Services)this morning and explain the situation and let them take over your moms care from here on out.
Dealt with one that was definitely on the facility's side who took great pride in offering no assistance when facility lost the appeal to evict with no 30 day discharge notice and planning. He didn't even arrange for a ride from the facility, even though it was no cost to them.