Who is responsible for finding Mom an orthopedic doctor that takes her Medicare/Medicaid?

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She's in a NH w/dementia, alzheimers, congestive heart failure, renal failure and falls daily. My niece has POA, I have the checkbook and write 3 checks a month. NH takes all but $60. She has a water meter charge and electric bill each month that is way above the $60. She fell again late Oct. 2016. I found out when I received a call from ER to come pick her up! I have vertigo and couldn't drive then. I called NH, was told someone was on way to pick her up. 4 hours later, ER called again. I called NH angry and upset. She had been there since early that morning. My niece went after her and tore into the director at NH. She hadn't had food either. 2 nights ago, I got a late call that she had an appointment the next morning with her othopedic surgeon. I didn't get the message in time to make arrangements to pick her up and take her. Last night, I got a voice mail on my cell phone that they have been told not to use except in emergency, that they took her to Dr. and he refused to see her because she had no X-ray that was needed. And another call from business office informing me they needed over $100 for co-pay for the visits to the Dr. because he didn't take her medicare and her medicaid only helped pay for NH. I told her to find another Dr. and she told me to let her know when I did. Me??? I was informed by a nurse at one of their sister NHs that they were responsible for all of that since she is under their care and had been placed in the NH by her Dr for rehab and her own safety. I was surprised that they called about her appointment since I never know when she goes to the Dr. I knew the first 4-5 months and took her myself but, her insurance will only pay the NHs primary Dr. I am constantly getting bills for X-rays, Dr. Visits, meds, etc. And the collection agencies are calling saying I am responsible. I hang up on them. I see her every week. Do her laundry since if they do it, stuff disappears. Her granola bars, fruit and protein drinks disappear. She says the nurses get them and drink them. I do not know if it is true or not. She is in a memory unit. I cared for her for the past several years driving back and forth almost daily, picking her up from falls, doing her shopping, visits to friends, etc. I was exhausted, started getting sick, tore all the tendons and muscles out of my arm and suffered a couple of TIAs. Dr. said stop and rest. I am now trying to get the brother to whom she willed everything to help me clean out her house and sell some of her things to help with her financial needs. I was forced to drop insurance on her home but will keep the taxes up to date as long as possible. Brother refuses to help me even though she was paying his bills right up to the date she was put in the home. He will not work and has said he is selling the house and everything because it is his. I changed the locks with the POAs blessings. I have very little left in her account and it goes down about $40 to $50 a month. If I can't sell her furniture, the account will be gone before the end of the year. So, I can't afford to pay co-pays to Dr.s. My husband is in his 70s and I am getting there fast. We pay for the items we carry her and I pay for haircuts, extra clothes (she has lost a lot of weight), etc. With those items and the cost of gas each week, I am spending about $100 a month of my SS which is $652 before insurance. What would you do about a Dr.? Thank you in advance

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Moms house title is in her name only. There are 3 of us siblings. I am oldest then my middle brother who actually paid for the property and house and the vehicle mom wrecked a couple of years ago by working weekends and after school before he married. (I always thought he should have had everything left to him or mom should have put it in his name). Then there is the youngest, who is our half brother and lazy as the Texas summers are hot. He will not work. He is 57, weighs about 400 lbs and is a whiner. And he is the one mom left everything to. He lived with mom until about 8 years ago when she literally kicked him out. He lives with his common law wife and she works and gives him an allowance. I tried to get mom to change her will to a life estate before her memory started going bad but she wouldn't. She is extremely controlling and has obsessive control issues and a short fuse to her temper. She cut herself off from friends and family over stupid things. She lost one friend when she ordered the friends son to move out of his moms house and quit worrying her. This after the son had a stroke that left him mentally incapacitated. A nurse at her original Drs. office told her she didn't look 85 and mom started yelling at everyone telling them the nurse called her a liar. Just a few of her "good" things she has done.

My niece who is POA, is one of my middle brothers daughters. She works 6 and 7 days a week at her business, visits mom as much as possible between work and her daughters needs. I respect her decisions and since mom had put my name on her bank acct to sign checks (moms hand were twisted & she shakes bad), she lets me take care of the paying of monthly things due. She takes care of legal papers, medicaid and medicare forms and plans and the signing of NH papers. An elder attorney has said that medicaid will take the property probably. There is no lien on it at this time. The POA has told me to sell private items if needed to help pay her personal needs. My youngest brother hasn't been to see her but once or twice since last June. He always got her to put a tank of gas in his truck when he went to her house to visit or help with yard work. I will not give him a single penny of what is left in the bank. He has accused me of wasting moms money. I have every receipt, bank statements, insurance forms, tax statements, etc. to prove I am not wasting her money.

I do have to have a serious talk with the NH this week though. Mom got $3 a month cost of living raise and they raised her portion of the bill to almost $4 more a month. Now she will only receive $59 per month to pay bills and I spent 2 hours tonight tracing Medicaid laws in Texas. She is supposed to receive $60. I also received a bill from the Orthopedic Surgeon today for another visit. They carried her to him even after we told them to find another doctor that took her medicare and medicaid.

Hopefully I will get to see her Friday or Saturday. I and 8 others in the family have had confirmed cases of the flu and I haven't seen her in two weeks.

Thank you to all of you for your advice, ear and help. It really helps relieve worry and stress to know someone is here to listen and offer help.
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I too suggest doing a title search on the house. If she is on Medicaid as stated in the answers above, she will be subject to MERP. I would think her NH would keep a list of providers that accept Medicare/Medicaid patients as primarily NH residents have those insurances.
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The son cannot sell anything, he doesn't inherit till Mm dies. The niece should be paying the bills if she has POA. I'm assuming Mom is private pay? If so, talk to Medicaid. She can have a home. They will put a lean on it so if sold they get their money back, if she passes, or Medicaid will stop to you spend down any profit. You should request hospice and the NH has to comply. The hospice nurses will work with the NH. There are certain things Hospice pays for that u won't have to. In my opinion, Mom's property should be sold if there is not enough money for bills. And pulling the water meter? You better check with the municipality to see if that can be done.
You are not responsible for Moms bills.
I feel the facility is only responsible for making appts. for Mom if family is not involved with her care. You need them aware that Mom only has so much money. There is none for Drs. that don't except Medicare and/or her supplimental. With ur Mom's health issues not sure why she needs an orthopedic doctor. Really feel you need a Hospice recommendation.
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In a nursing home, your primary MD is the doctor at the nursing home. He is the one who coordinates her Medicaid and the nursing staff makes the appointments. The niece is responsible for all the financial stuff, including selling off any personal property or real estate.
That takes us to health care proxy, which I assume is you if the nursing home is calling you. Resign that in writing to the nursing home.
No, you cannot sell anything; niece has that responsibility.
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I presume your niece is POA over everything because you and your brother can't agree. Is she his daughter? I would like to make my niece my POA because my two kids don't get along and I trust her, but she lives 400 miles away.
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You do not specify who has medical POA to make decisions. Did the NH attempt to make several calls before making decisions on where to send her?
You can control the doctor visits and make the appointments on YOUR TIME. If your are notified about an upcoming appointment, you should be responsible to change it.
Unfortunately, NH with its low taxes offers some of the worst medical care to seniors on Medicaid which leaves out of pocket expenses.
One thing you can do is since she is having several falls in a nursing home, it is unacceptable and that is a red flag. Each state has an office for reporting including an ombudsman. Medicare and Medicaid have put nursing homes on notice that funding will be reduced to them for reports of falls and poor compliance. Her nursing home should have systems in place to prevent those falls.
As for your brother, he only receives any moneys upon her death. Do a home title search to see who owns the property. Her POA will need to step in to sell the home. She will need to spend down the proceeds before she can receive Medicaid. The government will not look at her household belongings so her son can take those items. If her POA does nothing to resolve all of those bills then you can petition the court for guardianship and conservatorship. Mind you legal fees will be a few thousand which can be charged to her estate. Igloo 572 offers good advice. I would also offer to stop using your own money for this. You have your own health to look after
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Cherokee- you mention "all she has is $60 a month". So is she on Medicaid?

So on Medicare AND Medicaid? If so, did you, her bro & dpoa neice understand that Medicaid is required to attempt a recovery from of her estate (MERP) of any assets?

That house will become an asset of her estate. It could well have a lein placed on it already, if your state allows for that. Her brother - who believes he will inherit the house - may or may not due to MERP. MERP can be dealt with but IMO will require someone within the family - usually the one to be named to be executor in a valid will - to file timely responses to MERP, gather any documentation needed for any exemptions & exclusions AND more than likely opening probate. Meanwhile from now till whenever merp &/or probate closes is paying all costs on the house which remains property of mom while mom is alive or an asset of her estate when she dies.

For an elder to keep their home as an exempt asset as allowed by Medicaid can work if family is all on the same page as to dealing with all house costs & there is a reasonable expectation that estate recovery can be dealt with successfully. Sometimes house gets rented. Sometimes family just pays & does whatever needed (maintenance, repairs, taxes, utlities, insurance, etc). Whatever way there needs to be someone with the time, wallet and sense of humor & desire to be the point person to deal with a property not in their name and wherewithall to deal with merp & probate. Please Realize house may or may not get past estate recovery lien or claim, so there is risk.

If you've found you need to pull the water meter as you cannot afford it, you all imo cannot afford to continue to keep this place. Pulling utilities places house into not being insurable, not even a vacant dwelling policy. Perhaps look to rent it to cover costs. Or have that brother who thinks he will inherit it pay for all.

Or just sell it and have a spend-down done & deal with Medicaid re-eligibility.
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"I cared for her for the past several years driving back and forth almost daily, picking her up from falls, doing her shopping, visits to friends, etc. I was exhausted, started getting sick, tore all the tendons and muscles out of my arm and suffered a couple of TIAs. Dr. said stop and rest. I am now trying to get the brother to whom she willed everything to help me clean out her house and sell some of her things to help with her financial needs."

And "... am spending about $100 a month of my SS which is $652 before insurance."

Why does your brother inherit everything and not you? I just can't understand when parents do this sort of thing, and also can't understand why the non-inheriting sib(s) do anything at all for their parents when this is the case.
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Your mother's bills are her bills and, after she dies, the bills of her estate. They are not yours.

In some places people 65 and older can defer property taxes until they die. This might be worth looking into.
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Mom isn't under her normal Doctors care any longer and not under hospice but, I believe she should be. My niece and I went to the NH for a care plan meeting this past week and they want to start her on speech therapy because she is choking when she tries to swallow. It is apparently happening a lot. Also, they had not had the Xray done that was needed for the orthopedic surgeon they carried her to. We tried to get info on why they took her to the surgeon that didn't take her insurance and didn't get a satisfactory answer. They were the ones who made the appointments. The woman in the business office also told me a different amount was owed for co-payments. It was half of her original amount. She also told me their elder attorney said that medicaid would take moms property which is 3 lots and a 16'x80' mobile home.
My niece and I talked it over and decided to have moms water meter pulled so we won't be paying a meter charge of $500 a year for not a drop of water. The brother she is leaving it all to was not happy and has decided to remove items from the home, sell them and keep the money. There are a few things that are worth anything that could be sold to help pay her bills, dr. co-pays, extra clothing, etc. My niece who has durable/indurable/health/financial POA for her is also executress of moms will and has told me to change the locks on fences, sheds, house, etc. if I want to.
She and I spent time with mom after the meeting and we were both really upset with moms downward slide. Her eyes and cheeks are sunken and pale. Her skin is dry with veins on top of the skin and she was shaking and unable to sit up by herself. She knew me but couldn't figure out who my niece was until we told her. It is getting so hard to leave each time but, I make myself go not knowing if each time will be the last visit.
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