My mother is in assisted living. Her Alzheimer’s is getting worse and she's out of money. She doesn’t qualify for Medicaid. What do I do?

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My mother is in assisted living. Her Alzheimer’s is getting worse and she's out of money. She doesn’t qualify for Medicaid. What do I do?

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My mother has no assets, nothing left but her social security and VA payments she gets. She’s just short of qualifying for Medicaid. The qualification limit is $2,349 and her income is $2,457! Her monthly expenses come to $4,823 each month.

Her Alzheimer's is at the stage where she is paranoid, aggressive and aggravated most of the time.

My mother is 96 and physically healthy.

Part of her problem is she’s been spitting out her pills because she thinks they are trying to poison her!

Of course, most of those pills are to calm her emotional state, so they brought in Hospice Palliative Care to be a part of her care now. The goal is to find a way to administer her meds to make sure she’s getting them in her. Temporarily they are using injections and creams to try to get her back to the point she was just two months ago when she was mostly calm and happy. Recently she’s been going into rages and she slapped two nurses! That is not my mom. She wouldn’t do that in her right mind.

Anyway, she needs much more additional care and at the same time she’s out of money. The last of our resources was cashing in her life insurance policies.

So now she can only afford half of the cost to stay there. I’ve exhausted my research resources trying to find financial help. Up until just a few weeks ago Medicaid allowed subtracting a quarter of the VA money as “non-income“ which would have let her qualify. The government just took that option away. This has been their policy for at least a few years if not more, because I checked on all this a year ago so I wasn’t worried about her qualifying.

The Medicaid person I spoke with said they were all shocked when this order came through a few weeks ago. They have many people on Medicaid who use that system. So....I’m stressed to the hilt...she only has one more month she can pay and I don’t know what to do.

My mother must be in a facility with 24 hour care. Living with me would not be possible.

She lived with me for 7 years before Assisted Living.

Have any of you gone through not qualifying and desperately needing financial help? If so, what did you do?

I appreciate any comments and info.

thank you.

Alzheimer's & Dementia Behavior Change Paying for Care Violent Behavior

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You are saying that "they" are having trouble, so I am assuming that currently Mom is in care and "they" are saying she must leave?
What are Mom's other bills? Other than paying where she is now?
Sounds as though you are in a dreadful situation and I couldn't be more sorry for it. Is there a way that all assets of Mom's monthly can now go to a facility automatically.
You say she has other expenses, and there would not be money for them, so they would simply not be paid. Mom is on hospice now.
I think most importantly is that you must NOT take Mom home. To be frank, without someone accepting her though discharge they cannot chuck Mom out into the street, and their social workers will have to find a way to keep Mom in placement.
If you throw up your hands, it may come down to their seeking guardianship of the state, who will step in to manage Mom's assets and bills. But if you do it, they will let you.
Best thing you can do is hand them, if you are her Financial POA, the files, and wish them good luck. When they start on "what are you going to do" tell them that you can do nothing". Because honestly I don't see WHAT you can do about any of this. Have any of them made suggestions?
I hope someone else has a single idea what you can do. I surely don't.

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She is in assisted living they do not accept Medicare or Medicaid they do accept VA at most AL’s they can discharge her with no penalty they are not governed by the rules as long term care. I know you may be able to find her a great dementia unit in a nursing home and open a prepaid burial plan at the funeral home sign her life insurance over to them and pay the extra toward her burial plan and then she will qualify for Medicaid. I’ve seen this done tons of times.

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My brother in law was able to qualify for Medicaid even though his income (social security and small pension) were slightly over the limit. In our state, Medicaid will subtract regular medical expenses from the monthly income when computing eligibility and computing what the person's share of costs must be. Brother in law has Medicare part D (prescription drug coverage) and a Medicare supplement plan; deducting those from his monthly income put him within limits for nursing home Medicaid. However, I suspect the rules are different for AL, but it's worth checking out. Also, if your mom has dementia, she may qualify for the NH level of care even if physically she doesn't need that level of care, and the Medicaid regulations for that are different than for AL I believe.

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HI -- I note you are in Indiana, is that where Mom is? I think Indiana allows Miller Trusts, to solve this problem, but you need to see an elder care attorney ASAP. Not just any attorney, an experienced elder care one. Good luck

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The first thing to keep in mind is you do not have to take her home. In other words do not let the facility discharge her to you. They cannot do it. It is unsafe and unethical. They must find an appropriate facility if they choose not to care for her anymore. Now, on to qualifying for Medicaid. What you need to do is set up a Miller Trust where the excess money over the state limit is deposited. I would see an attorney to do it. Some choose to do it themselves, but I would have an attorney set it up. She can qualify for LTC Medicaid. Then, if the facility she's in now doesn't have a bed, she'd have to transfer to a SNF that does. But you do not take her home, the facility she is in should help you find another location for Mom.

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I don't think ALs are under the same laws as a LTC facility. You lease your room. You pay rent. Even my daughter, who works in a hospital, says hospitals can do an unsafe discharge. LTC facilities cannot do an unsafe discharge.

I don't think an AL is obliged to help you find another place. Moms had no SW. These places are businesses. Our local one lost their accreditation with Medicaid and the families of those residents receiving it had to scurry to find other facilities.

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Are the VA payments Aid and Attendance ? If so, she can't have both. The A & A will drop off because Medicaid pays more towards care. (She will receive a PNA from the VA) There are ways to get get around her having too much to qualify her. In my state there is a Miller Trust which may go under a different name in your state. The overage goes into that trust, and when the person passes, it reverts back to Medicaid. You may want to consult with a lawyer well versed in Medicaid. Does her now AL allow Medicaid at any point. My Moms u had to private pay for two years at least and then apply for Medicaid.

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Find the best elder care lawyer. Use her money to pay the lawyer...never pay out of your pocket....... she'll have to spend down her money to qualify for medicaid. You can just refuse to take her home....very hard to care for someone with dementia....I've done it.... horrible disease to see a loved one suffer like that...

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Her monthly income is too high to qualify, not how much she has in the bank! Big difference.

(6)

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Aanie; where is mom living right now? Is she in her own home or in a facility?

If this is a sudden change of mental status, has she been tested for a UTI, which can cause psychiatric symptoms?

yes, you need an eldercare attorney who understands Medicaid in her state.

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She can have a high share of cost and be on medicaid. The V.A. resourses may be there. If a medicaid elgability is a issue...always have in the plan to "return home" even if will never happen (if there is a house involved). Hospice is involved and they deal with behavior. Be sure you are not trying to "hang on to" her resourses.
Medicare pays for hospice.

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I agree with other posts, you can probably find ways to qualify for Medicaid, a lawyer can help to do this, they can interpret the rules and have done for others, it takes a bit of time to get all paperwork and finances in order so will not happen in a few days or weeks. While you are getting things in order, look at medicare.gov website and find the best possible Medicaid eligible facility-try not to accept whatever social worker at current place will locate for you-i have to say you have to do your own home work, research first is a must. SW at my sister last community says to me I see you are having a rough time finding a place-oh no you just figured this out after I have been digging for 6 months-while SW was processing health records request for Sis application to a new place. . SW then tells me the place down the road is all remodeled and they are taking new residents. I was familiar with the name he mentions then I review my research the place had been cited for abuse. Since covid this lovely place that was mentioned had capacity for 85 residents something like 70 got covid a number of them also died. The best medicaid facilities I was able to locate for my sister had long wait list, I was put on several beginning in December 2019 none have called me due to covid and we would now have to reapply for Medicaid all over again due to not locating a bed during application process. Sis was in nursing care we did not know that they were not medicaid when we moved sis into the place-assisted area seemed fine and thought her placement in LTC would maybe not be necessary once behavior was under control with meds. -the place was awful-injuries, weight loss, med errors, bad food and bad caregivers bad case of scabies spread like wild thru her unit. Several professional people who provided services to my sister said they would send their family to that other place we were in.....which is partly why we went there plus sis was combative and almost no where will accept more difficult behaviors around here. while also telling us her previous community nursing care was awful which it was.

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You have been missinformed. You need to contact the Medicaid office regarding getting your mother into a skilled nursing facility and applying for Medicaid. Most facilities will be able to help you with the application. Eventhough your mother's income may be over the income "limit", that doesn't mean she doesn't qualify. Medicaid will require you to do an Income Trust/Miller Trust document and there is a process involved with maintaining the account. You also need more information regarding how VA is treated when applying for Medicaid. The VA benefit usually consists of VA Pension and Aid & Attendance. When applying for Medicaid, the A&A portion of the monthly benefit is not considered "income" by Medicaid - but the pension portion is and will need to be paid to the facility while waiting for the Medicaid application to be approved. Once approved, you are required to notify the VA and eventually the entire benefit will be reduced to $90 - which your mother will be able to keep each month, in addition to her monthly allowance ($30 in SC). Again, I would recommend that you seek help in this matter and be careful not to take advice from people who don't know what they are talking about - when it comes to getting your mother the care she needs.

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I just spoke with my elder care attorney about this same situation yesterday and he confirmed what was stated above.

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If you can obtain an attorney, that would be best. If not, Apply for it anyway. The claims adjusters may take things into consideration and approve her for it. God Bless.

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I just read something about a “Medicaid” or “Miller“ trust?

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There is a little red tape involved, but this is solve-able. See a Medicaid attorney -- not an elder care attorney -- in your area and they will help you. You will need to supply bank accounts and spending on your mother's accounts for a bit of time --Medicaid can ask for 5 years, but usually don't. But definitely see a Medicaid attorney right away and she/he will give you the steps to follow and assist.

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I have to be quite honest, I am surprised with her funds so low, Medicaid will not take her. Not sure why. Talk to the Social Worker in this Facility or maybe in another Facility...The laws in this could not have changed this quickly because of COVID. It has been this way for a long time where if you ar eprqactically broke, you can get Medicaid....

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I was a Minnesota County level nursing home financial worker as part of my career, and unless things have changed entirely ( I doubt that), she can have what is known as a "spend down". You pay bills after checking in with the local agency and applying for MA on her behalf, save the bills and receipts for payment, and when her income gets low enough within the month, she should qualify. Check also if she can have any assets such as a small savings account prepaid burial, etc.
Rules vary by state. If she owns her own home, they may put a lien against Medical Assistance (Medicaid) payments made for her care. Study the MA pamphlet they can give you and consult with a Financial Worker there (free) before you hire an expensive lawyer. God bless yo for looking after her. KBHKBH

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Great advice below!
As for her meds, my dad did the same so we crushed his meds and added to applesauce and he willing took meds this way.

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Have you reached out to an eldercare attorney? Dont go by what your state Medicaid offices tell you, a good eldercare attorney can find a way most of the time

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You have to do a Millers Trust. Contact an Elder Law Attorney and they will help you get it set up. It is a pain in the a** but it's what is required when ones income exceeds the Medicaid limit.

Take care.

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Unlike Social Security and Medicare which are purely federal programs, Medicaid is a shared expense between the individual states and the federal government. Miller Trusts do not work in every state.

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https://www.medicaidplanningassistance.org/medicaid-eligibility-indiana/

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Great advise above. Take heart an elder law attorney with expertise in medicaid is very necessary. You will get her situated and her care paid for.
Mom sounds as if she needs more caregivinģ than given in assisted living.
This will work out.

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First some meds can be put into put into food or drink so you may have to make an extra effort to crush the med into powder form or take it out of the capsule. This seems to help with the idea that she is being poisoned. As far as the additional funding needed, if her husband was a Vet or she was a Vet, apply for Aid and Assistant Benefit through the VA. It could be a helpful extra $1200 towards homecare assistance. Lastly, look into CBD oils or tinctures as an aid towards a better mood. This has helped with sundowners or aggresiveness. Check with her doctor first.

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Quick query-do you know of a brand of CBD oil that is effective? There’s just so many and they’re unregulated so I’d love a recommendation. Thanks!

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afterthought, veterans will only if in wartime service. My husband was in Berlin Crisis and he does not qualify for benefits.

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Not necessarily -- he should ask the White House VA hotline about talking to someone, as the VA has drastically changed under the current Administration. It's faster, more informative and much more streamlined.

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Sounds like you have not been talking to the right people.
See an Elder Care Attorney and he will stear you in the right
direction. Their are all kinds of legal ways your mother can
qualify for assistance even though it may appear she does
not qualify. Take someone you trust when you visit the lawyer.

Pay the attorney, Believe me you will get back more than you
pay him. He knows the legal ways to get people qualified. Their
are always exceptions to the general rules.

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I wasn't aware you could have both Medicaid and VA at the same time (it's been a couple years and I know it changes). But, if that's the case, would it be possible to drop one or the other ~ qualifying her?

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I just wanted to say that I'm disgusted, living in the richest country in the world, that we have beg, borrow and steal to take care of our elders. Shameful.

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Also feels like we have to do that for ourselves because if you’re a primary caretaker of both parents and your in your 40-50’s you can’t get health insurance at a decent
rate. Health care shouldn’t financially cripple us or make us choose worse conditions for our aging parents.

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I am so sorry that you are going through this stress! We found a solution to my mom spitting out her pills - we grind them up twice a day (pill grinder from CVS or Walgreens) and mix them with a tiny bit of CBD honey and put them in a croissant or cookie. She sees what we are doing, and still willingly takes the "treat". We have 1 pill that was recently added at night that can not be crushed, so we have to talke her into swallowing it first before getting her "treat". So far it is working.

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What did the elder law attorney advise? They know exactly what to do and charge about $200.00 for a one hour consultation. I went 3 times over a 4 year period. Worth EVERY dime. Go see a good one and get references before you choose. Wishing you luck.

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ONe friend I know uses the excess $$ to prepay her funeral expenses , thud coming in under the limit. Check with the person reviewing her eligibility.

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It's worth the few hundred dollars it will cost to get some advice from an Elder Law attorney who is well versed on spending down for Medicaid.

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National Academy of Elder Law Attorneys, www.naela.org

even though counter-intuitive, an even better source to find an attorney, the Special Needs Alliance, www.specialneedsalliance.org.

You need an attorney in the state that your mother lives in. Although the states need to comply with the general federal program, Medicaid rules vary state by state.

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My mother is in assisted living. Her Alzheimer’s is getting worse and she's out of money. She doesn’t qualify for Medicaid. What do I do?

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