What happens if your parent does'nt qualify for Medicaid for a nursing home? What if they insist on going home?

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My father-in-law is currently covered under Medicare for a 90 day stint in a nursing home for physical therapy/rehab. He is complaining that they "get him up" and he just wants to sleep, doesn't want to eat (they have him on an anti-depressant and an appetite stimulate in addition to his other meds) and he will not use his walker when going to the bathroom. He wants someone to lift him up, one or two people drag him to the toilet, wait 10-15 minutes and then haul him off the toliet again with him either fighting you the entire time or not even helping to pull some of his own weight.
My husband and him had a come to Jesus meeting tonight and he was told he has 2 months left and then everything is out-of-pocket. We have priced what it would cost for an aid from an agency to sit with him 24/7 and it is actually less expensive than a facility however, he has only enough savings to pay for 2 months. I am guessing after that, they will take the house.
What happens if a person's pension is over the amount to qualify for Medicaid? Does he get moved to a less expensive facility?
My husband is power of attorney, but I am guessing my father-in-law could still sign himself out when his stay is over and go home. He told my husband tonight that he can't afford help and expects him to take care of him. My husband works full time plus and was already doing 4 visits a day to his dad's house in addition to visiting nurses, one assistant, one volunteer. My father-in-law says that that was just not enough.
There is no other family that can help. We unfortunately are it and if he moves in with us, I will have 90% of the responsibility of him and I am in acute renal failure with other health problems and cannot lift and take care of him.
Since my husband is POA, can he be held legally responsible if he father chooses to go home and he doesn't essentially move in with him?
My father-in-law has drawn an excellent pension for over two decades and the majority of it has been blown on gambling and playing big-shot. We have already said we are not taking our daughter's college fund to pay for better care.
Can my husband be forced to legally take him in or move in with him?

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babylon1919-forgive me for not reading all the posts but I have a question about the Medicare coverage after a 3 day hospitalization. You say With SNF, you must have a 'qualifying hospital stay' of 3 days before being sent to the SNF. Then Medicare covers 100% of the first 20 days and after that pays the major portion and most if not all medicare supplement plans pick up the remainder. After 90 days, Medicare won't pay at all and so the supplement doesn't, either. '

Are you saying that Medicare will cover 100% if the individual is getting care such as OT/PT and making progress, this is the case? But this would be in postacute care situation, correct? if the individual is NOT making progress, facility must alert Medicare that no progress made and then Medicare will stop paying after 2-3 days, correct? I am under the impression that Medicare will never pay for SNF in the situation where the individual is not making progress and then the decision is left to consider care in the home with home health aid or family that can provide care or consider self pay for SNF or apply for Medicaid. Am I correct about that? Am in this situation right now with my mom who is self-paying but won't have the funds for long, hasn't applied to Medicaid an potentially might not qualify, and am not independently wealthy enough to pay for unspecified number of days in an SNF. REturning to home is likely out of the question as too much money to fix problems in the house. Thank you for the clarification.
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joycews There are things you may need clarity about to be more focused in order to organize the situation and less confusing for all the matters involved.
Nobody is responsible for another person's debts unless you hold an account by documented agreement, such as joint ownership of property, unless otherwise stated and legally filed. This all depends on laws, county state, etc.
OR... if you signing an agreement taking responsibility for that debt or admittance charge.
If someone is unable to care for themselves , or is a harm to his/herself and none is willing to take on the care role willingly or someone find a care situation plan that will be for the best quality of life and to selflessly benefit the person solely. It needs to be handled by Law for Government decision is made for them to become Ward of the State. In other words no one gets thrown into the streets in their diapers and left to die there.
So your choices are....
Use the power of attorney to organize a care plan, medically, financially, etc. this means you need to use his money for his care and quality of life. This dose not mean you need to sell a house to pay for care right away. If he's living in the house and his income is spent on the maintenance, bills etc. what's left over is considered available income, check those details for sure,you can only use what he owns as payment unless they find out he/she has given gifts or undocumented loss of money. I suggest you call the board of social services in the county, of the home residence, and ask questions. Have them mail you the list of things needed for medicaid application. So if he is being released you have a head start and you can say we working on a plan. Pay with what you can access of his ....what you can for now .... you can't be forced, you can only agree or refuse a situation. If anyone tries to tell you "you have to take him home", you don't!!! Unless you agree to it, or agreed already.
If you choose not to do this..... the government (county, state) will eventually need to be involved.
If you don't want the government to decide what happens to him or his assets, just be involved and prepared. Believe me they are more loaded down than you so whatever is easier to make the social workers, billing dept., jobs easier, and that you are willing to pay for him by way of POA, make it "known", and that you are on top of it, on his behalf and working with them to plan a way for his care. You will get answers if you ask the right people and research for resources available for his needs.
We all pay into the government resources and it is all there for a reason ....
There's a need!!!
Last word of advice is... Do what he needs for his care .... looking for agreement is sometimes pointless if he knew what is best for himself you would not need to be here in the first place.
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Thanks L,
Most everything above we were doing before he was in rehab at the nursing home now. He had Meals on Wheels and cancelled it because the food was not up to his standard. He will not eat left overs -- so us preparing meals and him warming them up in a microwave is not an option. He tells us everything must be prepared fresh -- at least 3 times a day.
He will not use a wheelchair to take himself to the bathroom. He was using a walker for a while, but there was also problems with cleaniness because he rarely feels the need to wash his hands.
Before the hospital stay/nursing home, my husband was up to 4 visits a day and was just informed last week by his dad that it wasn't enough that he needs to do more.
He wants to be lifted from his seat and essentially carried and placed on a toliet. He is 6 foot approx. 180-190 pounds. Before the rehab stay, he would have someone with him and still call my husband to come from work and pick him up to take him to the bathroom.
He is on anti-depressants but they do not really help.
There is no option of bringing him home with us. It would be a bargain to lose his house than kill ourselves taking care of him. My husband's health has improved in the month his dad has been away.
But those are the reasons he is going to have to have someone 24/7: he won't eat left overs, won't use meals on wheels, won't wheel himself to the bathroom, etc. I know he wants my husband to move in with him, but he says he is not doing that. He is 86 and my husband has told him if he doesn't work at rehab, he will lose his home and I honestly do not feel he thinks we are serious.
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If he is non compliant and not improving he will be kicked out. Sounds like he has emotional issues. Maybe when he is sent home he will regain a bit of will to live and wok harder at increasing self reliance.

He sounds difficult, not nearing the end. I dislike every NH I have ever seen and acknowledge their value at end of life, but he may regret going to one too early.

If released, take him back to his house. Visit frequently, daily or stay over in the beginning to see if he is safe.

I believe Medicare will send a nurse for catheter care.

Load his meds in a weekly box so you can track and ensure he takes them, call him to remind him. Look at the box when you visit to verify he is taking them.


Meals are not that complicated. Your county may have a meals on wheels program. You do not need to be on Medicare to qualify.
Bring him treats, leftovers, have him over for dinner, bring dinner and eat with him. Both you and your husband can do this. My 17 year old nephew used to drop by on his grandparents, sometimes he mooched a pizza, the grandparents loved the visits.

Your husband or a care giver can be hired for baths, even ALFs provide this service only 3 times a week.

The toughest thing is toileting, since it cannot be scheduled. If he can at least wheel himself to the bathroom or commode and safely transfer onto that, that would be a big help. My dad was mobility impaired following an amputation. As most elderly men, he needed to pee a couple of times a night. 80 year old mom could not lift him into the chair and trying to get to the bathroom in the middle of the night was dangerous. 4 male urinals lined up on his nightstand were the solution. The Internet had some pricey but cool non spill models, but the cheap ones from Walgreens will do. This can be cleaned daily.

When hunger or nature calls and there is no one to carry him, he will use his walker. It may be wise to get him a wheelchair, if he is not steady enough for the walker. Also get him a personal alarm or have him carry his cordless or cell phone and do keep in close touch.

Hiring someone to help with these kinds of chores can be fairly inexpensive, it will not require 24 x 7. This certainly will allow more of his pension to remain in hand to go towards taxes and house upkeep. Once you go into Medicaid NH, they get the pension. If his house needs to be sold to avoid the taxes and upkeep, the NH becomes an irreversible decision.

Try this for a couple of days, and asses. Do not bring him to your house from the onset, he will have no drive to improve. In the meantime exploring Medicaid eligibility is a smart move, as he will need a NH at some point.

This is still a lot of work, but if you bring him to your home he will only transfer his reliance from the staff to you. Remember this is a family problem, regardless of the solution you should not have to take on 90%. This is your husbands father after all.


Best wishes,
L
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No.

Having POA does not give someone the authority to determine where someone lives nor the responsibility to take them in. Dad can leave the NH unless he is legally incompetent to make his own decisions. If the NH determines he cannot live on his own, other agencies may get involved but no one can force your husband to move Dad into your home, or to move in with Dad.

Perhaps it varies by state, but here my husband's pension was over the Medicaid guideline and all that meant was we had a deductible ("spend down") to pay each month.

You are considering private pay for 24/7 coverage at home, but Dad only has assets for 2 months. For private pay "they" won't take his house. The agency will simply not continue providing the service. If Dad sold the house to have money to pay them, he would have to move somewhere, such as to a subsidized senior apartment is that is an option.

When you figured that it was less expensive to pay for at-home care than to pay for NH, did you include home ownership expenses such as property tax, insurance, routine upkeep and maintenance? Did you factor in food costs? None of those things would apply in a NH.

Whether it would be better for Dad or more economical for him to be in a care center or with help at home is almost irrelevant because he cannot afford either. You (or your husband, the POA) need to figure out how to get Dad qualified for Medicaid as soon as his money runs out. Medicaid covers nursing homes and also has a program for in-home help. (In-home does not typically include 24/7 care, because at that point it is generally most cost-effective to go to a nursing home.)

If/when he goes on Medicaid, "they" won't take his house, either. BUT if he is in a NH most of Dad's income will have to go to his care, and he will have little income to pay property taxes, etc. And the state has a claim against the house when Dad dies.

If Dad is not cooperating with his therapy he may not get to stay the full 90 days. Medicare covers rehabilitation, but rehab isn't happening if Dad is totally noncompliant. Discuss this with the rehab center so you are not caught by surprise.

I'm sorry to say that if the level of care Dad was getting before the rehab stay is no longer sufficient, and he cannot afford additional care, then something has to be arranged for him as soon as possible. And it may not be what he thinks he wants/needs, because he cannot afford that.

But to answer your primary question, No, it is not the POA's responsibility to provide care directly -- only to see that Dad's money is used for his care.
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So you are saying that he has been in the SNF for about one month and he has 2 months left?

SNF (skilled nursing where you get rehab and therapy) isn't the same thing as living in a nursing home for custodial care.

With SNF, you must have a 'qualifying hospital stay' of 3 days before being sent to the SNF. Then Medicare covers 100% of the first 20 days and after that pays the major portion and most if not all medicare supplement plans pick up the remainder. After 90 days, Medicare won't pay at all and so the supplement doesn't, either.

HOWEVER, if you are thinking about his long term care being given in a nursing home environment, you then would apply on his behalf for 'long term' medicaid insurance which is different than regular medicaid, which is certainly what you are saying he doesn't qualify for because of the pension. Unless he is really wealthy, he should qualify and there is a lot involved but I can't see why he wouldn't qualify.

What they do, ultimately, is allow whatever the State's required stipend amount is each month to be put in a trust in the nursing home he lives in with the remainder going to the nursing home to pay for his room and board and the rest being covered by medicaid.
POA does not imply financial responsibility by the agent by the person granting the power of attorney. In other words, just being POA makes no change in the fact of responsibility for bills but just means that your husband must be responsible in handling your FIL's money to pay your FIL's bills.
That may change with guardianship but I don't know anything about it. I doubt that is an issue since you didn't mention it. If so, then NO...but be sure and do NOT take him home at the end of the 90 days if NH placement is what you decide is best. Best if he goes straight from the SNF to the regular NH status, and very easy, too, as far as logistics, if he is going to be in the same facility.

I know all this about the SNF stuff for sure because my mom just did a 90 stint, too. And we might be going back for another due to new developments...and if so, then she has to be in the hospital again for that 3 days qualifying period. If it goes that way, then Medicare will start count on a new 90 days where they pay all of for the first 20 days, etc.


And I also do not think anything can be forced upon you either because of the family connection or the POA. There is no law that says an adult is not responsible for themselves unless guardianship comes into it. And like I said, I don't know what that entails.
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