My 91-year-old dad was just transferred to lock down at his assisted living home. If it is to expensive can I move him to a nursing home for less money?

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I have a 91 yr old Dad who has been in assisted living for about 5 yrs. Approximately 4 months ago he was transferred to the lock down memory care unit as he wheelchaired his way off a couple of times. He has now become alittle more aggressive in behavior, 100% incontenent and does not walk very often. He physically has experienced many medical problems, heart, lymphoma, TIAs. Home is raising care to over $4400.00 month. I lost my husband to cancer 8 months ago and have been supplementing Dad's care and now with the increase in care, my income is now preventing me from supplementing Dad. He has VA assistance, SS and small retirement which has not covered his costs and will definitely not cover the raise in care. I can't seem to find additional financial help for him. He has no assists. My only brother is financially strapped and difficult for him to assist. Can my Dad be put in a nursing home? I cannot find anywhere close that would accept Medicaid/Medical. He needs care 24/7 and I cannot bring him home with me as I have a one bedroom and would not be able to lift him. Does anyone know what I can do to make sure Dad has a good, secure environment? Where can I go for additional information or help. Thanks, Lynn

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The answer is yes! The above answers are great! So glad to be surrounded by so many great people to help others. Check with your local Alzheimer's Association to see what resources including nursing homes with a "safe haven" that might be available for your dad. If an Alzheimer's Association is not in your area check with the assisted living he has stayed in for all this time about other options in the area. Granted we (as the professionals offering a service) hate to see someone leave yet if it it time for whatever reason they should know the resources in their area. Wishing you strength, courage and happiness with those in their days gone by,
Deanna
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Jeanne's spot-on.

I'd like to suggest to you to gather up all & everything financial related to him and buy a spanking new notebook with pockets and start getting/writing down everything as you need to start the Medicaid application process. And find out where the closest Kinko's is too.

As I see it you really have two different (but intertwined) projects: to get him qualified for Medicaid both medically & financially under his state's Medicaid rules & find a facility that will accept him.

Yes, please ask admissions where he current is, if they accept residents on Medicaid and do they do "Medicaid pending". Most of them I've found follow what I call the Devil Rule: the devil that we know is better than the devil we don't know.
If he's been there for a while, they know his needs and more importantly the level of manpower (their cost) needed to have him as a resident. If he is a low-level in needs then they probably want to keep him as a resident.

Most states have it where Medicaid will NOT pay for AL but only for NH, which is now referred to as LTC - long term care. Some states have waivers for AL but the residient has to already qualify for medicaid to get the waiver. IMHO you really need to be looking for a LTC facility for him as he will eventually need to move from a AL to LTC and you're doing this fun project again.

That he's a male is a plus as some facilities want to have a bit of a balance in the sex of residents so it's not all female. Really.

Medicaid pending is VERY important. What it means is the facility will accept whatever his monthly assets are as his total payment while he is going thru the medicaid process. Let's say Dad has $ 500 in SS and $ 1,200 in retirement and $ 100 in VA. His total monthly assets are $ 1,800 and that is the total amount that the facility needs to get while he is going thu Medicaid application.

If they don't do MP then if his rate is $4,400 mo - 1,800 assets then you must pay the $ 2,600 difference.

Admissions can tell you about what they do or don't accept. If they take Medicaid, then work with them to have him stay there. Transfer trauma is very real for the elderly and you want to avoid that if you can.

Regarding Medicaid assets-
This is all determined by each state. Some are $2,000 max, other states $ 2,200.
You need to find out what his state is. Then determine what his monthly assets are and any other assets. Remember the asset is the total amount he gets and NOT the amount of the check he receives. So if his retirement is $ 1,200 but it actually is $ 1,000 paid as $ 200 goes for a secondary health insurance policy,the amount Medicaid is looking at it $ 1,200 in assets & NOT $ 1,000. Many elderly are having $ 200 - 400 a month taken out of their retirement/SS, but it's the whole amount that counts for their asset ceiling.

The LTC/AL should give you a list of things they must received in order to turn in his Medicaid application. It's pretty specific: 3 - 6 months of his bank statements; burial & funeral policy; any and all retirement EOY statements (SS send this out in Jan); all insurance policy's (this is sticky); brokerage accounts; citizenship;
letter from all his banks regarding any account closures in the past 1 - 4 years (this is especially fun to deal with). How the list of required documents is done varies by the NH in wording but it's about 20 items. Whatever you do, make 2 copies of everything: 1 whole set goes to the LTC with the application, the other you have in a notebook. Never give them an original of anything.

The NH/LTC is required by the state to give this documentation with the medicaid application to the state's liason to that specific NH/LTC. The NH is merely the messenger. Once the application is submitted by the LTC to the state,it then goes to a specific caseworker. In the Medicaid application, you as DPOA, sign off for them to go thru the patients financial life. They can contact they bank, old employers, IRS, life insurance companies, etc. without letting you know. So don't try to be cute and leave any $$ out, as it will surface.

I am very OCD when it comes to paperwork, for my mom's application I turned in over 100 pages from bank statements to front & back copies of life insurance & funeral policies. Even with all this, there still were issues with her insurance.
Get this - it's a term policy has a face value of $ 1,000 that she did in the 1960's
(when that was actually real $) - I had to submit the policy 3 different times for review. The problem was that the old-school policies were done like a novel with a ton of pages that make no real sense so it's hard for the caseworker to figure out.
Now that her policy is under the $ 1,500 limit set by her state (Texas) for assets
didn't matter, it was all about the caseworkers being able to check off the square for term life insurance rather than whole life insurance. Whole life IF it has a cash out value will need to be cashed out before Medicaid will pay BUT term life doesn't as it is paid after death.

Now if his assets are under the ceiling, great. If they are not, then you have to spend down to that point. Dental work, a really good walker, new eyeglasses, hearing aids, etc are all good for that. A burial policy is too as long as it has NO
cash conversion. If he is in the spot where no matter what his retirement monthly is set at $ 2,500 a mo and he will ALWAYS be above the ceiling, then you need to see an elder care attorney. There is a vehicle called a "Miller Trust" that can be done. For my "aunt", we did this as she had a RR retirement (RR pays really, really well) - what Miller does is establishes a trust account that all the extra money goes into for the lifetime of the person and becomes the property of the state upon death. So if his money is say $ 3,000 mo & state ceiling is $ 2,200, then every month $ 800 goes into the Miller Trust and Voila! he qualifies for Medicaid. These are sticky and you must have an attorney with elder care expertise to do it. Ideally you want one who is based in the county/parish where dad lives too.

The Medicaid paperwork details can make you crazy - that's why you need to start a notebook and keep all this in 1 place to review.

The caseworkers really don't make much money or need much education for the job, so be patient. The more information you provide with the initial application the quicker you will get him accepted financially. If you don't, they will stamp it insuffient or even worse "non-respondent" and you will have to start over. Alot of the requests from the caseworker have to be answered within 48 hours, so again the notebook with all the info and location of Kinko's is muy importante.

The LTC will do the medical necessity for Medicaid. You really won't know this is happening unless there is a problem as you will have to submit an appeal as the MPOA for him. I had this with my mom as she was admitted with only 1 Rx and they left off the list the other RX's that she was prescribed but refused to take (hence why she needed to be in LTC rather than IL or AL). It got cleared up rather easily but still.....

If he has a home, he can keep it but be aware that he will have NO $$ to pay for property taxes, utilities, etc. If he has a home, post that & I'll answer what you want to do to get reinbursed/credited for all that.

Good luck. Enjoy your father's day too!
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If your father, with some family help, has managed to pay for 5 years of assisted living, he has done well. It sounds like it is now time to arrange some public assistance.

Have you discussed this in detail with the care center he is currently at? Many (but not all) facilities will not admit new residents on Medicaid, but will accept that in payment for resdents that have been private-pay for a number of years. They have allowed in their overall budget x slots at the Medicaid rate and they reserve those slots for current residents when their money runs out. So first, talk to them. If they will accept Medicaid for him, they will also help you with the application process.

Is there a VA home with the necessary facilities in your area?

Maybe you will have to go farther away to find a suitable placement that will work financially.

This is very sad. I'm afraid many of us will outlive the money we will have available for our needs after retirement. I think the whole economy should be bracing for the huge wave of need we can expect as the baby boomers are no longer contributing to the gross national product and also needing more services, in many cases more than they can pay for.

But you, fortunately, are not responsible for the national economy, but only for finding suitable placeent for Dad. That is a hard enough task! Best wishes to you (and hugs) while you deal with this challenge.
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All abpve answers were great I would that have the social worker at the nursing home you choose do the leg work with you provididng as much as you can-I found this out when sitting in the socail worker's office haveing a meltdown and crying a sea of tears she was able to do in 10 min what I had been trying -playing phone tag for 2 weeks also an elder lawyer which can be paid for by the elder will be able to help-he or she will ask you for a retainer which can come out of the elder's assasts probably for 3 hr.-the elder lawyer- fee so you can asume he and his staff can do it all in less than 2 hrs-do not be pround and try to do it by yourself-believe it will drive you carzy. Remember the elder is responsible for his or her LTC cost-not the family if he oe she has to spend down it is their money that is being spent-in today's world very little is passed on the the family-our money we saved during the years is for our care-you can prepay for the funeral-it is much different for the spouse that is another story and a sad one at that-of course you want to keep copies of everything and any paperwork sent in should be certified with return receipt and I wish you well you can do it-another thing I would say from experience the best nursing home is the one closest to you .
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You are not responsible for your fathers bills. What state are you in? I am in NC and elder help should be able to give quidance. Your social worker at the place where he is now should have a meeting with you to discuss what he ( personally ) is available for, not the familys money. Even if he owns his home he should be able to get into the nursing home. However, if he has cash on hand they may want him to spend down to $2000.00 cash. Another thing go to your local county Social Services and see how they can help and perhaps get him on medicaid. There are some rest homes that will take him. The homes like to keep it quiet to the public, but they have so many beds desiginated for people like your dad. The work involved is hell but keep fighting because there outlets out there. Do-not bring your moneys into the conversations. This is far from normal.. Good luck and God Bless you.
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Rosebud - if the parent is a resident of a state that has filial responsibility laws on the books, the children CAN be held financially responsible for paying for the filial support of the parent.

Some states have actually done this - Pennsylvania does this thru State Act 43 - so it is something to be aware of when you sign mom &/or dad into a facility in those states. Google to see if your state is filial responsibility.

I believe it has to be where the resident and the adult child both have legal residence in the same state, but I'm not 100% sure on that.

Another reason to really be prepared when you do the Medicaid application so there are no reasons to have mom unqualified.
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I have received some very good advise and am very appreciative. Thank you! I did find that my Dad qualifies for entrance into a VA home. We are in the process of completing the application. I have taken numerous points of each response and am in the process of checking those out. Thanks again for all of the help!
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Good luck with all and don't be afraid to ask questions. If you don't understand a proceedure, policy, or answer, say so. Also, find a 2nd person, sibling or friend, who would be willing to attend meetings with you. This period of yoru father's life brings a lot of stress and confusion and it helps to have a 2nd set of ears and another person to help you to absorb the info, especially the medical stuff.
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I agree with austin, Talk to the Social worker at the nursing facility,

But if he is currently at a hospital, a Social worker over there should be able to assist you as well, I understand about the health issues, I have so much knowledge about Ivs and wound care and meds and other things that a normal 30 yr old would not have ever known. I understand your distress.

This site is here for people like us. Not just for the good times but the hard (huh) understatement, the times when we wonder if that is all we are here for,

So your mission is talk to the social worker either at the hospital or the nursing home, Your dad will get in. They understand elder care and the family's concern.
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I am glad everything is working out for your dad, You know what is best and do not let anyone tell you different.
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