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Appreciate in advance all advice an help. My parent are mom fragile ocd micromanaging mother, but current situation has her beside herself, she cant eat, sleep, stressed out, crying daily. She is needing lots of assistance from me. Yes, I live in the same town, but I am currently a full-time student and full-time mom to my grandbaby. So our delimia is my dads a 6 ft. 2 tall strong man, my moms really small lady, well he started falling and it got worse and worse, mom cant help him up when he falls she started having to call fire department and or ambulance, finally he hurt himself and would get super confused when these falls happen, sometimes he might fall in the night and just lay their for my mom to find the next morning. My mom begged him to holler at her or something he would get confused and wouldn't call on her. Finally a hospital stay that resulted from a fall ended him up in a nice local nursing home, the problem is my dad has humana and partial VA benenfits but my mom is having hell getting them to pay for him to be there, and as of right now she is having to appeal everyday or every other day herself thru all kinds of steps to get him another 24 hours or 48 hours to stay then they say they wont pay nursing home anymore and she has to appeal again. this has wernt on for over a week and its about to do my mom in but no she cant afford the almost 300 a day it would cost for him to stay without his insurance. She cant physically have him come home she cant even help him to bathroom or give him a bath and he cant at all do it alone he is in a wheel chair now at the nursing home and wetting himself daily multiple times. ANY helpful advice or direction would be so helpful, As long as the advice isnt them paying out of pocket because they just cant afford it. TIA Sincerley frustrated daughter.

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See an elder care lawyer if you plan to cover LTC with Medicaid. My mother needed to move assets into her name only and do a spousal waiver.

Good luck.
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Reply to Hothouseflower
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A house and car are exempt assets with Medicaid. Its a little more involved when there is a couple involved. You really need to talk to a Medicaid caseworker. Tell them Dad will need LTC and they have no assets but their bank acct. Mom will become the Community Spouse, remaining in the home, having a car, and enough or all their monthly income to live on. Social Workers at these places don't always know the ins and outsbof Medicaid especially when itsca couple. You may need to see an Elder lawyer but first, see a Medicaid caseworker.
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Is he in Rehab? Medicare and supplimentals only pay for Rehab. Is his Humana a Medicare Advantage? If so, they should be paying for his Rehab. I would think Advantages have to follow Medicare criteria which is 20 days 100%, 21 to 100 days 50%, the other 50% is the responsibility of the patient unless they have a really good supplimental. Once the person has 100 days in and needs more care in Rehab, its now out of pocket or you apply for Medicaid.

If Dad has met his 20 days, Mom will need to pay that 50% that is not paid by insurance. Thats why his insurance won't pay. They are not contracted to. If they don't have the money, then apply for Medicaid.

I am not familiar with VA benefits. I do know that Dad has to be registered with them for health benefits. The two men I know who are, use the VA hospital for their doctors and health needs. Medicare is their primary. Va is their suppliment. Its easier to get into Long-Term Care with Medicaid than into a VA nursing home. Those with service disabilities are taken first into VA homes.

You and Mom should sit down with the finance dept. That person can explain to you what is being paid for and what is not and why. I think Dad has reached his 20 days of 100%. He now will owe something. If you think that he will need Longterm care, that he can't come home, then its time for Medicaid. You may want to consult with an Elder lawyer if Medicaid is needed. Mom needs to protect her half of their assets. Dads half going towards his care, when almost gone, Medicaid is applied for. Once on Medicaid, Mom remains in the home, gets a car, and enough or all of their monthly income to live on as the Community wife.

Sorry, Mom probably owes something. When she signed the financial papers they should have said what would be her responsibility. The facility predetermines with the insurances what their responsibility financially will be and that should be all written out on the financial papers.
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He may qualify for a VA facility.
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Reply to brandee
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Have you or your mom contacted the VA directly? He may be eligible for a VA nursing home.
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Or actually I think they have Medicaid but then picked Humana as a extra provider or something like that and my mom hates that they picked it, or maybe its Medicare and they picked Humana ....idk like I said I'm completely new to all the lingo.
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ShirleyDot Apr 21, 2025
It sounds like they have Medicare and picked Humana as their “Advantage” plan. Medicaid is when your don’t have enough income to pay for a NH. I would see an Eldercare attorney to help you sort out their options. It’s a very confusing system.
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Have they applied for Medicaid? If not, perhaps they should.
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Reply to MeDolly
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Your dad will need to go on Medicaid to have the nursing home continue to be paid for. Start by finding out if his current place will accept Medicaid payment. He may need a different place if they won’t. Don’t assume using Medicaid means less care or a worse outcome. My mom was a in nursing home four years, going from private pay to Medicaid, all in the same room, same care. Meet with the business director where dad is to ask about this. Then see an elder care attorney to plan how to structure your parent’s finances to best use Medicaid. It will not leave your mother broke. Applying for Medicaid is doable, but if you want help reach out to your local Council on Aging for advice. I wish you the best in a tough time
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pinkanc Apr 17, 2025
My mom mentioned in passing that they wont qualify for Medicaid. I think she is just assuming. There home is owned by a trust and besides that they have one car paid off but besides money in the bank to live off of there isn't really anything else, and my mom cant just run herself out of every dollar trying to keep him in there, but Ill take your advice and at least ask about the Medicaid or should we consult an attorney before applying for Medicaid. TIA again for all the advice so appreciated.
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Join the club!
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