My aunt is a resident of MI and we need to relocate her to AL. What do we need to consider first? - AgingCare.com

My aunt is a resident of MI and we need to relocate her to AL. What do we need to consider first?

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What steps should be taken to move an aunt from one state nursing home to another who has living children? She can't walk and they can't determine why. She's about to move from rehab to the nursing home. Please tell us what to consider first. Thank you.

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I moved my aunt from Michigan to Ohio. She was in a pay as you go facility in Mi. I moved her into a medical care facility in ohio that took Medicade. I paid her room expenses until she was eligible for Medicade. The facility handled the process for me. I was her guardian in Mi. So applied to have guardianship transferred to Ohio. All went well with no glitches. All of the folks involved were very helpfull concerning their involvement in the process. Before I moved her I visited all of the nursing homes in our area and picked the one I thought she would get the care she needed.
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Dawg - you really have 3 different area that need to be addressed & carefully thought out in all this BEFORE you move her.
1. Medical - You need to clearly & carefully speak with her MD and any other specialists that have evaluated her in MI to see what they anticipate her ability to walk & do any ADL's will be or if she is going to be bedfast & what level of care within that and will they discharge her to move. Then with that information in hand clearly speak in person with admission & nursing staff at the NH that you are looking to move her into in AL.

When I moved my mom from NH#1 to NH#2, the nursing staff went for a site visit to see if mom would be suitable for their facility, basically to determine if she was OK for the level of care they provide. And my mom was still able to do her ADL's and was pretty cognitive as she had Lewy Body Dementia. I would be concerned that if you are not being bluntly descriptive with the needs required for your aunt to the NH's in AL, that once she moves in, you end up getting a call & letter within a couple of weeks that although they just love Auntie, they cannot provide the level of care she needs and you have to move her (she gets a 30 day notice). That is a total panic situation as once that happens, she will needs placement in a specialty facility.

Ask if Auntie could be evaluated for hospice - if she is OK for hospice, moving her to another state may not be in her best interest.

2. finances - right now being on rehab, your aunts stay is being paid by Medicare. the first 21 days @ 100% and the rest of the 100 day maximum @ 80%. How is she paying her 20% & how is she going to pay for any facility once discharged from rehab & Medicare coverage? As others have said, NH are expensive and are paid either from LTC insurance, Medicaid or private pay. Does Auntie have the funds to private pay for several months at the new place in AL - I'd say 80/90K for 1 years stay & medical transportation from state to state. Medicaid is state administered so you need to see just what needs to be done to have Auntie eligible for AL Medicaid (become a resident of the state, etc.). We dealt with some of this for my MIL when her NH closed in LA due to Hurricane Katrina and they moved enmasse to TX - everybody was covered by TX Medicaid, but within 6mos all had to become a resident of TX and any who had a home in LA were not approved for TX Medicaid as the property in LA was not an exempt asset so they were ineligible. Medicaid's approval can take months and the facility may require a contract to be in place for you to be financially responsible to pay for her stay if she should not be approved by AL Medicaid.

You will need quite a bit of information and documents on your Aunt for the Medicaid application - like her awards letters from her SS and any retirements - if you have not been involved in her life on an intimate level before all this, you may find it daunting and very difficult if you do not have DPOA paperwork already done.
The AL NH should have a list of the documents needed for AL Medicaid. Remember that for Medicaid, all of Aunt's monthly income is required to be be paid to the NH as her co-pay or SOC (share of cost). All she will have in extra $ is whatever AL has as it's personal needs allowance (runs from $ 35 - 105 a month depends on state). If Auntie needs new clothes, or personal care items, etc and it runs over the allowed monthly PNA, then you are expected to pay for this.

3. legal - she probably will need new legal done that will be acceptable for AL. If you are not already named her DPOA or guardian, that may need to be done in AL courts. Guardianship is somewhat cumbersome and has more costs than getting a DPOA & MPOA done. But if she is bedfast, then doing the POA's likely isn't feasible anymore. Guardianship maybe 7-10K to be done and you pay for all costs up-front and if you are awarded guardianship then you can be reimbursed for your costs IF Auntie has the funds to do so. If there are any issues in your or your households past (like any felonies, bankruptcy, foreclosure, etc), the judge may not award you guardianship but instead place Auntie as a ward of the state with a vetted by AL courts guardian.

I'd suggest starting with the medical to see if really truly it is feasible for her to move out of state. Good luck, it's going to be daunting if Medicaid is needed.
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If she is a ward of the State if Michigan, she is not going anywhere.
Consider that her insurance stops at the state line. Medicaid stops at her county line. All the expense will be on you.
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Does she have enough money? Nursing homes are really expensive, but probably not as much in AL. Check out all the nursing homes in AL BEFORE she leaves the rehab center. Then transfer her directly to the AL nursing home if you can coordinate services between doctors/social workers, etc. It is a logical nightmare so be prepared.
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Get online and look up nursing home compare, , the site will give you info regarding each facility. You can call and speak with the long term care ombudsman about the facility you are considering, while the ombudsman can't make recommendations, she/he can give you info on a facility. What's the payor source? If she will be long term Medicaid and not private pay, they you need to make sure she will qualify in what ever state she is moving to.
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I agree with these ladies. You've got quite a bit of detail work ahead of you. You've got to think in detail about her insurance coverage/funding resources, where she is going in AL, what doctors/specialists she's needed in MI and plan for same in AL. And yes, is she her own guardian? So, first? Gather all these details first. Good luck & God bless.
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As a native of Alabama, I can tell you it will depend on where she is locating. I grew up in the Birmingham area which is very nice. Cook Springs, which is about 20 miles east of my mother, is very nice. There are very high end homes around the 280/Greystone area.

Alabama is not cheaper than other states. But it is poor and has many on Medicaid. The state is in financial trouble which may or may not be a problem.

I am sure it can be worked out. I start by contacting SS/Medicaid/medicare for information. I am sure someone who has been there and done this will have a great deal more advice than I do. Good luck to you.
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My mom had some income four years ago when she moved in with me. Since then the cancer she has is under control but about a year ago age developed NinoAlzheimer's. The first thing that happened when moving her from Fla to Georgia was her part b carrier said that they don't service out county. I had to go find a new part b carrier and close behind that a part d carrier. What a pain.
She is now living in a nursing at assisted living facility did not work for her after she fell three times in one week injuring her hip. We now pay $6000 a month. When she runs out of money we will apy for Medicaid.
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Do you have POA? If not, don't think u can do anything at this point. Why aren't her children involved?

We needed to transfer my MIL from Fla to Atlanta. SS at the rehab were big help but we kept hearing "we don't take her insurance". After hearing this 5x, it was found they didn't except her insurance because it was only good in Fla.
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