What are the options for Mom (80) if she gets Medicaid? - AgingCare.com

What are the options for Mom (80) if she gets Medicaid?

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My mom is in the hospital now after she fell 2 weeks ago & never got any treatment then but the pain got so bad she must have fallen again & defecated all over herself & I found her sitting in it so I called paramedics to take her to the hospital.
So the ER doc told me that she will be there for a while, then I should consider putting mom in a nursing home since she shouldn't be living alone anymore & can't get around very well.
My mom receives Medicare & Medicaid.
Only $686 a month social security.
Has no savings, no other assets.
She does have a reverse mortgage on her home which is about 50% tapped out.
She can only get another $50,000 left from the RM.
Where can she go to live & get the care she needs after her hospitalization ?
I'm afraid because she is so low income that if its a nursing home it will be a bad one where patients are abused & mistreated.
Have heard horror stories & seen video of nursing home residents being battered by the staff, I don't want my mom to end up in a horrible place like that..
We live near Chicago.
Please help!!!

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The big question is Medicare vs Medicaid. Mom was on Medicaid when we had to move her to a nursing home and it was very hard to find one than accepts Medicaid straight out. IF HOWEVER, she goes to a nursing home that accepts both right from the hospital, hopefully they will accept her as a Medicare patient and then put on Medicaid. I had to put Mom into a decent but not my first choice nursing home because she was on Medicaid. When she ended up having to go into the hospital for a week, we were able to have her relocated to a different home where she went as a Medicare patient and after that ran out, they allowed her to stay as a Medicaid patient. Several administrators have told us this is common. It is very rare a place would "kick someone out" after the Medicare eligibility runs out. I would suggest visiting places NOW so you are not forced to make a snap decision. Good luck!
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Good luck, hanging!
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I would like to move my mom back to her house.
Pay for nursing care (24/7) w/the remaining $ left on her RM, then when that runs out, she may have to go to a NH that Medicaid will pay for.
If my mom outlived her $ from the RM, then I will have to deal with where she will go.
It's all too much right now.
I have been prescribed Effexor from my doctor today for anxiety.
Hope it works.
Thank you for all your help & suggestions everyone.
You have no idea how much this helps me.
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Hanging - my suggestion is to get mom into whatever facility that can provide the type of rehab she will need after she is discharged from her hospitalization. Rehab post hospitalization is a MediCARE benefit and Medicare will pay 100% for the first 21 days and then @ 80% up to 100 days.

The great part of having her in rehab is that it creates a window of time to work out the whole "stay or move" & house situation without mom being at the house. Do what you can to be positive about her rehab to keep mom on track with "progressing" in rehab so that she can stay ok for the maximum # of days under Medicare coverage.

The RM is probably going to be a real cluster to deal with. RM's have a pretty specific compliance requirements for the RM to stay in force. If they move from the house, the RM will be called in. I'd be very cautious in taking the remaining line of credit (50K) left on the RM and then mom moves into a NH and out of the house. Doing this could be viewed as a fraudulent gain of funds under the terms of the RM and you as her DPOA could be held accountable. If the house could sell and repay all the principal, fees and settlement charges on the RM, it could work out but if there is a negative balance on the RM, you could face issues in doing this. Understand?

Remember mom is responsible for paying all taxes, insurance, repair, utilities on the property under the terms of most RM's. Taxes are coming due in January for most areas too. Defaulting on any of these, could place additional fees on the RM.

How long has your mom been on Medicaid? You kinda need to find out to see if your mom start date for Medicaid is within MERP rules for Medicaid recipients. If she got onto Medicaid after 2005 or 2006, she's under MERP. All the states now have a requirement (MERP) that if they are over 55 and on Medicaid for LTC and most community based programs, that the state has to attempt a recovery of all Medicaid paid on them from their assets. If the RM gets paid off and there is any extra $ left, it will need to either be used to repay the state for Medicaid costs paid on her OR she will need to spend down the amount as she will be ineligible to continue on Medicaid due to the increase in her assets (her share of the proceeds from the sale of the house left after the RM is paid off). There will not likely ever be any funds left to you as her heir or beneficiary of the trust. So keep this in mind if there are any costs on the house that need to be paid between now & whenever it's sold.

Regarding PACE - this is kinda the new current trend for community based services for the elderly. There is a one by us (Benson Center, New Orleans) and it provides a pretty wide & encompassing range of services & activities. But one thing to keep in mind for PACE, is that family is expected & required to be able to provide any caregiving or support needed when the elder is not at the PACE center or a PACE provided caregiver. If there is not family able to fully do (or family hires & pays for caregivers) whatever coverage gaps exists apart from PACE, then PACE is not going to work for you. Also if the # of hrs needed for care and provided within PACE exceeds a certain # of hours (maybe more than 32/38 hrs a week) then they will be discharged from the program as the cost/benefit is over the formula for effectiveness. They are better served in a NH or other skilled nursing full-time caregiving facility. Ask social worker & nursing staff at the rehab place as to what realistically what mom will need as far as day to day support services to go back to live on her own.

All this is a lot to deal with and your gonna be overwhelmed. Try to break things down and have mom stay in rehab as long as possible within Medicare rules to get an idea of what the options are (or aren't). Good luck and keep a sense of humor going.
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Hangingon61: Okay...hope you're successful.
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I am not responsible for any of moms debt, but the house will go to me if she died because I am the beneficiary of her trust.
If I want to retain any profit from the sale of the house, I will need to repay the rm what is owed (zest money my mom has used so far, including interest), then of the sale exceeds the amount due, I would get the remainder.
If house sells for $200,000 and mom owed $170,000, I would get $30,000 I suppose.
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I thought that was the whole purpose of an RM. They pay and at time of death the houseis sold and they get what they paid out or the house if paid more than the house sold for. Also, Medicaid will put a lean on the house if they pay for her care. You are not responsible for your parents debts. Any assets they have will be split among the debtors. What is left goes to survivors. Watch what you sign, never make yourself responsible for a parents debt.
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Llamalover I know that the rm will need to be repaid but I don't have any funds to do that. I will have to sell the house & hopefully the sale will pay off what's owed.
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I hope that you aware that the RM has to be repaid when she deceases.
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HangingOn - The apartment my mother lives in is HUD controlled. The rent is income based. Your mother can be a PACE participant in her current home. Moving my mother to an apartment was easier and less expensive for us. The rent and utilities and less expensive than utilities, taxes and general upkeep of her house.

My mother also requires 24/7 care. So working with PACE we are able to cover her this way...

She goes to the day center Monday -Friday.
8:00 a PACE provided CNA comes in to get her dressed and feed breakfast
10:00 the PACE bus picks her up and takes her to the center
4:00 she returns home - another PACE provided CNA comes in feeds her a snack and dinner until 9:00
We privately hired someone to be with her overnight.
The PACE provided CNA also comes in from 8-4 on Saturday. The rest of the weekend we cover.
The CNAs help with keeping her place clean and laundry

I feel like we have effectively created an assisted living facility in her own apartment.

My mother house is not a factor for us. She was able to use all the assets from her home to remodel, etc. years ago. The amount of the loan is greater than the house is worth so we will just return the house to the bank.

This arrangement is working for us right now and my mother is happy in her own place.

.
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