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Hi, My 86 yo mom was recently hospitalized for septic shock. She survived and went to a rehab where she has gotten bedsores, edema and remains incontinent (bladder and bowel) and has yet to get back on her feet. The rehab told me today that mom will be ready to come home on 12/23. I don't live in the same state as my mother. My husband does and he won't be home till the 26 at least and we cannot care for someone who is incontinent and barely able to move around. She lived with us in an apartment prior to getting sick, but we had come to the conclusion that she had too much alone time and wasn't caring for herself properly and were taking steps to make sure she got more attention. However, I am back in the state where I work and live most of the time and hubby is not going to take care of my mom full time as he works 10 hours a day. The nursing home said, ''that's fine, our business office will be in touch to quote a price for us to keep her through your husband's visit". She needs to go to assisted living we all agree, but I have no idea how to go about this move. She has Medicare and a supplement. What is my first step?

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I do so appreciate all the helpful advice. I have spent a lot of time on the phone from APS to the NH to the Ombusman to the Medicare dispute line. The NH has been way less than helpful. The Ombudsmand was a godsend. She explained a lot to me and pointe me in the right direction. I am going to do my best to gather up the huge list of documents they say I need to get a Medicaid application in place, but am not sure my mother even has most of the items. I did manage to get an appeal filed to keep her in the rehab for a while longer; they have up to 72 hours to advise me on that. Otherwise I guess she will just stay there and they can bill her for money she does not have. Being in another state, caring for a handicapped son, negotiating the sale of our current house and purchase of another and both of us working full time, and seeing my mother is such poor health has really taken a toll on us both.
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Clairesmum Dec 19, 2021
You do have an awful lot on your plate. Glad the ombudsman was so helpful.
The NH is a business, so they will focus on billing.
The details of Medicaid vary from state to state, so contact a free health insurance navigator (program similar to Ombudsmen for nursing homes, funded by federal money) to see if you can get more information.
Call Eldercare Locator at  1-800-677-1116 and ask for State Health Insurance Programs for her state. They can connect you to people who are trained to help people understand what insurance programs do/don't cover, and how to fill out applications. They don't give advice on a particular situation. They may be able to help walk you through the application and figure out where to find supporting documents.
The application requires your mother to
show who she is with supporting documents as to her identity.
show what her income is now, with supporting documents
show where her money has gone in the past 5 years, with documentation (bank statements, etc).
Once I realized that the form was 3 different parts with different purposes, and that each part needed documentation from the government or bank or tax records, it was easier to keep track of the whole mess.
Also, copy everything you send in, and send the package with delivery confirmation, so that it can be located if it 'gets lost' somewhere. Good luck.
and don't use your money for her bills. If the nursing home loses money, I wouldn't worry. and you are not responsible for her bills, even if they try to convince you that you are.
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Medicare & a supplement will not pay for Assisted Living or long term care of any kind. AL is not likely to accept your mother in her condition as it's intended for seniors who are fairly independent & only require minimum care; plus, it's private pay.

It sounds like your mother is in need of long term care in a Skilled Nursing Facility with Medicaid footing the bill if she doesn't have sufficient income to foot the bill. Speak to the social worker at the SNF she's current at for rehab; s/he can steer you in the right direction, most likely. You may also want to speak to an Elder Care attorney about the Medicaid requirements and lookback period in your state.

Like BarbB said, you can get a needs assessment done as well, but a doubly incontinent person is not likely to be accepted into AL. If you have Morningstar AL in your area, they DO take elders with more needs than most other ALs, but the monthly costs are also quite a bit higher. Your first step should be to speak with the social worker at the SNF mom is currently at, to get some guidance as to how to move forward.

Best of luck with a difficult situation.
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Speak to the facility's social worker. Let her/him know that you are unable to care for mom at home anymore, that she needs more supervision than you can provide. If mom needs to apply for LTC Medicaid, then you can help with starting the application for her. If the social worker at the facility does not seem very helpful to you, then you need to contact APS, or a state level elder care social worker and let them know mom's situation. They will step in and take guardianship if necessary. Please make sure you or your husband does not take mom home. You know yourself that your mom would be put in a dangerous situation if that were to happen, and you absolutely do not have to nor should you take her home. As far as any price the nursing home quotes for the days she is there that Medicare isn't paying for, make sure you don't pay from your own money. Mom's money only pays for that, and the NH can bill her.
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Thanks so much for the update, Tluther! Don't let the b@$tard$ wear you down...

Ombudsmen, like social workers, come in 2 varieties; great and terrible. Glad you've got at least one good one!
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The 1st step is to get mom a needs assessment.

If she has any assets, she will have to self pay until she has less then 2k cash. Insurance doesn't pay for LTC.

Someone is going to have to find a facility that meets her current needs and hopefully, her increasing needs until death. I wouldn't leave that to a stranger, I would have someone that loves mom do this. Even if you need to take a break from work. Because facilities vary so much, you want to make sure she is going to what seems to be the best choice for her. It may not work out that way but, you have to start there. look for some place that has obvious good interactions with the residents. Does it pass the smell test, how is the food? Do they have activities daily? It isn't necessarily going to be a new, fancy building, that is the least important thing.

Best of luck, this is such a difficult transition and the most stressful for you.
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Unsafe discharge.
Call her doctor, admit to a NH until bedsores are treated.
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Nusing Homes are a Horrible place to be sent to and their Rehab is a Joke.

I know this from experience.

They are all understaffed and you can literally lay in your urine and feeces for up to an hour.

They have special blow up mattresses that your mom should have been on to help with bed sores and they should have been applying butt paste ointment to help with not getting bed sores.

You should check with her Insurance and find our exactly what your options are and what is covered.

Your mom will continue to go downhill in a Nursing Home.
Please work something else out.
She needs to be taken out of the Nursing Home like yesterday!

You can have her signed up with Home Health where Audes will come 3 times a week to give her a Shower Bath or Bed Bath.

Mom can have In Home Therapy.

A Nurse will come by once a week to check on her and take her vital signs and she'll report to a Dr that can give rx's for healing the butt sores.

I found that virgin coconut oil does wonders for it but you must keep a thick layer of thick butt paste on the skin to keep moisture out.

If she can't get up to go to the bathroom. While in bed, she keep her laying on a diaper but keep the diaper opened so air can get to her.

You can check around and find Care help for $10 an hr you don't need a Nurse for Caregiver.

Praters your mom doesn't have to spend her end of life in a Nursing Home as it's a slow and painful death sentence in both physical and mentally.

Also, if your Dad was in the Military, your mom could qualify for up to 30 hrs of Caregiver Help a week.
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ZippyZee Dec 19, 2021
Friendly PSA to remind everyone to ignore any post whining about Nursing Homes from Bevthetroll.
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Do not bring her home - your lives will be disrupted and will be horrible until she passes. You need to live your life now as she has lived hers. Talk to different places and go and visit them. Whatever you do, DO NOT CONSENT TO BRING HER HOME - that is what they are banking on. Contact an attorney for help now.
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Have you had a care conference?

I would ask for a care conference and ask to see the PT and OT goals. Talk to the therapists and ask for documentation that she has met those goals.

Make them demonstrate to you that mom can walk 50 feet without assistance, for example.

Call the Ombudsman and report the bedsores and ask what can be done about them.

Is a wound care doctor tending them? Ask for mom to be seen by one asap. Or transfered back to the hospital for treatment.

And discharge to a defferent rehab.
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I will reach out to our county's APS and see what I can get going. I definitely need her on Medicaid and the Rehab told me her bedsores were healing, but the night nurse told me the wound care team was in earlier and put in a lot of new orders. It seems the rehab is not being honest and I am wondering if I should just send her back to the hospital where she will get a higher level of care.
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mstrbill Dec 16, 2021
The rehab facility just might send her back to the hospital anyway if you don't pick her up. They likely are looking for a way to get rid of her. That may be a good thing, then you work with the hospital to find an appropriate facility for mom. What would be ideal is you find a decent NH that will take her as Medicaid pending. Let us know how you make out and if you need further advice. Just remember to stay firm, and taking her home with you is not an option.
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