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After caring for my mother in our home for 6 years, she has reached a point where we can no longer provide the care she needs 24 hours a day. She is 85 years old and relatively healthy. Her Primary illness is Alzheimer's which has progressed to the point where she needs to be monitored almost 24/7.


We are now faced with the challenge of finding a safe and caring facility to place her in when she has very very limited financial resources and my family does not have a lot of money to contribute.


I am hoping through this forum to hear from other families that have already faced this challenge to gain insight into what suggestions they have.

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Agree that you might want to concentrate on non-profit organizations (they are becoming few and far between as senior healthcare facilities are increasingly "corporatized"): in my area of Springpoint Senior Living (formerly Presbyterian Homes) is a good non profit player as are many Methodist and Catholic facilities Confirm in writing that they will accept Medicaid. Make sure to visit the facilities you like several times (at least once during a meal time so you can check the quality of the meals) - get a hard copy of the menus for the month and of the scheduled activities. Confirm also that they have a dementia specific program and get a copy of the activities schedule.

In the LTC I worked for the finanacial payment source for individual residents was not available to routine caregivers; of course, the financial team, the DON and admissions people knew but the CNS and many of the LPNs were in the dark -- a resident was just that -- a resident. They did not know how a person's stay was being paid. In NJ the one difference about Medicaid is that it will only pay for "shared" accommodation unless there is a medical need (infection or noisy, large equipment that would create a hardship for a roomate); however a few of our private pay residents liked company and they opted for a shared room. Go figure that one! A couple of them became really good buddies. I guess they just like the companionship.

Good luck on your journey. It's not easy but you will come through it. Lots of love and good information on this forum.
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Reply to geddyupgo
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Midwest2021 Oct 30, 2021
Thank you for taking the time to respond. And your kind thoughts.
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Midwest2021: Imho, you should investigate a Medicaid application.
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Reply to Llamalover47
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Search on the Medicare website for nursing home ratings to find the best. Determine if they take Medicaid. Get her in as private pay even if you are down to a few months. When you apply for Medicaid, as a current resident she will bypass the wait list
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Reply to MACinCT
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You need the aid of professionals who can help you apply for Medicaid which will pay for a nursing home. Medicaid does NOT pay for assisted living. Please get an eldercare attorney or a social worker who can guide you. You cannot wait - it takes time and something needs to be done now.
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CarolPeaches Nov 14, 2021
In California, if a person qualifies for Medi-Cal, the state will pay for assisted living - assuming that is enough services for your mom. The state saves money by supplementing payments for assisted living. Call your local ombudsman to see if your state offers any assistance.
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There is income and then there are 'resources' that are considered when applying for Medicaid to get into a facility. Resources are things like bank accounts, extra properties, things that can be converted to cash. Look up Medicaid for your state to see what the income limit is for one person and what the 'resource' limit is - usually how much is in the bank. Let's say her income is under the limit, but she has too much in the bank. She would have to spend her bank acct down and would then be eligible for Medicaid. Her income, below the limit, would go to the NH to pay her part and then Medicaid would pay the rest of the cost.

If her income is over the limit, you can talk to an elder atty to set her up with what some people call a Miller Trust. Let's say the income limit is $2500 and her total income is $3000. Each month, $500 would go into the trust and the remaining $2500 would pay for nursing home. The money in the trust is also used for her medical needs. As a note, when they decide how much of her money goes to NH, they take the total income and deduct the cost of her Medicare insurance and the cost of something like a supplement policy. Also she will probably get to keep $60 per month to use as she pleases.

Medicaid looks back at the previous 5 years to see where her assets and money have gone. If you sold her house during this period and put the money in your bank account instead of hers, you will have to explain that. If she gave money or property away, you have to explain that. Gifting creates penalty months where Medicaid will not pay.

You can probably get the best information for your state by going to an elder attorney. They've done so many of these cases, they can tell you pretty quickly what she would qualify for and things, like a trust, that need to be set up.
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Reply to my2cents
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There is an alternative to putting her into a home. Look into in home care for her. There are programs like IRIS that will help her and you financially with her care. They give you the funding to buy her the things she needs and also to pay for who she wants to take care of her ...that includes you or any family members. They will pay for outside activities and care as well if she needs therapy not covered by her insurance.
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Reply to FamilyNeeded
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My 91 year old mom has been living in my home with my husband & me.
These last few years have been overwhelming. She has dementia & now sundowners.
Its best to get her into an assisted living facility. I was not sure who to reach out to.I got information to reach out to local Aging Adults agency. They are able to provide information. Also good idea to call Medicare( if that is what she has ) to get specific information on what services they provide. In my situation, I was told it’s best to start the process in December & by first of 2022, she can be placed. Only funds she gets is her SS. The place we find is based off on what that pays for. At the stage she’s in, as long as there are meals & occasional activities, she will be fine.
Also she won’t be a prisoner, so if other family members want can go check her out & take her places.
I am her only child. ( my older brother died suddenly in 2017) But there are several family members that live in our city. Oddly, no one has made any effort to visit her or take her while she’s been living at my home.
( so not holding my breath for any of them to go while she’s in the assisted living facility)
I know my mom needs 24/7 care & it’s best that I regain the role as her daughter, as now I’m definitely her caregiver & she sees me as her maid.
Her social worker and mine both have reassured me, it’s best to get my mom placed sooner than later.
Sadly, her dementia is going to get worse -progress.
Good luck 🍀
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Midwest2021 Oct 30, 2021
Thank you so much for sharing your advice and insight
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I am a state Ombudsman.

1). FIVE STAR RATINGS MEAN NOTHING !!!!!!
2) Citations are public info and the NH should have them in their lobby/facility for viewing.
3). Still, these items just offer a glimpse.
4) You have the right to request a Care Plan meeting at any time. You have the right to review a Care Plan at any time.
5) Speak up and don’t fear retaliation
6) Empower and Advocate
7) If something doesn’t feel right to you, it isn’t.
8) You have the right to review medical records at any time
9) If someone tells you how wonderful a nursing is/was to their family member, research on your own. Do you think someone will say, the nursing home my mom is/was in is just terrible?
10) If you don’t advocate and speak up, things will slip by.
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Isthisrealyreal Oct 25, 2021
I agree! The questionnaires that give the 5 star ratings are slanted to do exactly that.

I found that the questions were about the individual caregivers and not the facility as a whole, which sucked but, there were good caregivers doing the best they could. Such a shady practice.
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Go online and contact PlaceforMom. It is a free service and they can give you guidance and answer questions.
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Reply to PattiDK4
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CarolPeaches Nov 14, 2021
When I called they do not refer to any place if your mom has Medicaid. Something to keep in mind.
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The first step is determining how much money Mom actually has. If she has a house I would get a real estate agent to appraise the house. How much monthly income does she have? Then when you look at MC facilities you can ask do they accept Medicaid and will they allow a private pay patient to stay on Medicaid after a period of private pay ends. If your mother has a house to sell and add to or generate a savings account, she may be able to pay 1-3 years of private pay before needing Medicaid.

MC monthly cost = (monthly income) - savings drawdown

With a year or more of private care, she will be eligible for more facilities.
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Reply to TNtechie
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Call mom's call Insurance Co, Medicare or Medicaid if mom's funds are less than $2,000 total should pay for care.
Nursing Homes are understaffed so you do need to visit often at different times to see what is going on.
If person or spouse was in the Military, they should be able to get up to 30 hrs a week at Home Caregiving help.
You can also check about putting them on Home Health where a Dr comes once a month and a Nurse comes once or twice a month and an Aide will come however many times needed for helping to bathe, shower or bed bath.
I have them come 3 times a week for my 97 yr old dad.
Your Dr needs to sign off on Home Health that it's too hard to get the person in and out of car to get to the Dr's appointments.
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Reply to bevthegreat
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What the health care professionals usually tell you is to qualify her for LTC Medicaid by applying with the State, then visit various nursing homes in the area and apply to the ones you like. This is a lot easier said than done however as often you will find nursing homes that have no beds or waiting lists. Most residents at the nursing homes get there by private paying first and then transition to Medicaid or go there straight from the hospital. I've yet to see a story here from someone who was able to place their loved one on their own directly to a nursing home paid by Medicaid.

In your situation the first step I think is to call a state social worker or visit your local Agency on Aging and request help. Maybe they can help you find a facility. If that fails, the most reliable option to get placement is through the local hospital. (You have to convince the SW and CM there that you can not safely care for mom at home anymore). The case managers at the hospital have contacts and relationships in the community and are able to find open beds in local nursing homes. This is how I was able to place my LO. The tricky part is getting to the hospital in the first place. In your case it may not be so easy as you state your mom is relatively healthy. You may have to be diligent and plead with a state social worker to help find a facility for you.
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Reply to mstrbill
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With all that is said here also is your mother or her husband a veteran if so look into that. When we were looking for my BIL they asked that question if he was a veteran or a spouse of a veteran. At least I will know when it comes time for me or my husband that we will be taken care of because I am a veteran.
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Reply to Babs2013
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In our state, the first step to evaluate what level of care your mother would qualify for is getting a PRI (Patient Review Instrument) done. It is typically completed by a qualified nurse from a Home HealthCare Agency. The nurse may be able to advise you on facilities available to help your Mom. Good luck to you, your Mom and family.
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Reply to Cnbkra
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Please research the qualifications for Medicare and Medicaid. If she qualifies, please file for Medicaid for her.

Look for facilities near your that have memory care units and also take Medicare and Medicaid. Pick the one that will take her financial resources and best suits her needs.

Praying the best for you and her.
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RedVanAnnie Oct 25, 2021
Medicare is not likely to pay anything toward facility placement. Medicaid, maybe, if she qualifies.
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Also, look into Adult Day Health Services (also, in some states, like California but not Nevada, can be paid for by VA if she or her husband were spouses) sometimes called Adult Day Care. It was closed due to the pandemic from March 2020 on but that is starting to change (it's a slow re-opening, with partial services and lots of restrictions --hopefully after the Moderna/J&J boosters get going in next week or so, plus 10-14 days for them to be effective, they will fully reopen).
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Reply to Nonstop
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Yep. The answer is she stays at home and you bring in helpers.

If your Dad was a vet and was married to her at the time he died, she might be able to be admitted to a STATE-operated veteran's home. For the most part, all other options (involving SNFs that accept public MediCAID or MediCAL) are going to provide unacceptable care (bed sores, tranquilizers, saw one that let patients wander out onto busy streets where cars had to slam on their brakes, saw another that was about to lose its last CMS "star" --meaning they would be closed down even though they were still accepting patients, etc.)
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mstrbill Oct 25, 2021
Nonstop, helpers cost money. What if there is no money to pay helpers? Many folks don't have the ability to pay helpers and state resources (Medicaid) is usually very limited if it evens provides any help at all.
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I am happy to hear your mom is in good health! You may want to contact your local Office of Aging in your state. She may be eligible for other services under Medicare. Best of luck to you and your family!
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Reply to WrightOne
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Good luck as help is scarce and expenses high. Could you have someone come into the home to spell you. I totally get the money piece. I would be scared to put a loved one into a nursing home that was not high end. Stuff that goes on in those places is worrisome. I would look at in home care and I think medicare will pay some of it. Talk with someone.
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Reply to wonolancet
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Find several facilities that you are happy with and verify that they take Medicaid. Not all do.

My granny was in a lovely, caring facility on Medicaid and her care was fabulous. The caregivers would give her hugs and kisses as they walked by, she always had a smile and a playful spirit about her. This wasn't affected in the least by being in a NH.

I recommend looking for non-profit, religious facilities. They may not be fancy but, they are putting the money into the residents not shareholders.

As long as a place is clean, has ample staff, decent food and good care that is what really matters, not expensive artwork, fancy furniture, etc.

Visit several times at different times of the day, enjoy a few meals (most places sell meal tickets in the business office), speak with other visitors and residents, speak with the staff and see if they are stressed and short or kind and busy, because that is how they will treat the residents. Don't take to much of their time, just asking how they are doing will usually give you an idea of what its like to be there as an employee. Speak with executive staff and see how they support residents issues, their staff, etc.

Most importantly, ask if mom can age out and have hospice without having to move. Not all facilities will allow a resident to stay once on hospice.

Mostly, trust your gut. If something feels wrong, it probably is. If you can't speak to anyone except the tour guide, RED FLAG. If you can't just come in for a meal, red flag.

Taking the time now will save you great hassle down the road. It is time consuming and can be frustrating but, it will help you after placement.

Be weary of reviews that are on a scale of 1 to? These are questionnaires that have questions created to give them 5 stars when in fact the facility sucks. Trust the reviews that actually have residents family telling of their experience.

Contact your local counsel on aging and they can help you get started on the Medicaid application, they probably have a list of facilities that accept Medicaid.

Best of luck, this is a stressful time, be sure and breathe and take care of you by getting good nutrition and rest.
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Reply to Isthisrealyreal
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Finding a quality care facility for a person who has little money and will be relying on Medicaid soon is nearly impossible, but not entirely impossible.
Look for a non-profit care facility. Your best bet would be a faith-based one. Catholic establishments (hospitals, nursing homes, clinics, etc...) are usually non-profit. A person can get decent care even when they're broke and on Medicaid.
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Reply to BurntCaregiver
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emanes Oct 26, 2021
My mom was on Medicaid and in a hellhole of a NH, only because she had to go somewhere after rehab and at the time that was all that was available. I spent over a year regularly contacting nicer NHs and getting on their Medicaid waiting lists. It finally paid off and my mom is now in a first rate facility. She gets excellent care just like the paying residents. I know it's unusual, but it does happen. And for the record, the Catholic nursing home was unwilling to take her and would not explain why, and was not as nice of a place either. Every situation is unique.
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Just to encourage you in this often painful process, my mother went from using a LTC policy to private pay to using Medicaid all within the same facility and bed. There was zero difference in her care no matter which way the NH was paid. She received kind and compassionate care, for which we remain grateful. The business manager at the NH walked us through the Medicaid application process at no charge. Don’t assume that because a place takes Medicaid that the care won’t be good. My dad used what he called his “old people network” to find the best place, old people tend to be tuned in to what the good places are as they both visit people and monitor their own possible futures. And when the “all nursing homes are horrible” people on this forum come after you, please ignore. Know that you’re acting in the best interests of your mom, and you’ll still be her caregiver as you advocate for her in a new, safe setting. I wish you both peace
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BurntCaregiver Oct 21, 2021
Daughter1930,

My father too. He went from Medicare paid to private pay to Medicaid at the same facility. The place was crap across the board to begin with.
The day Medicaid started paying the care became almost zero. They downgraded him to room and board care where he basically got nothing.
You got lucky with the place your mom was in. That's unusual because there's almost always a downgrade in quality when Medicaid begins.
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If your Mom has no assets or a house, you don't need a lawyer. Dealing with a Medicaid caseworker is not hard. This is what I did.

Mom was in an AL running out of money. She had 20k left which would get her 4 months in an AL or 2 months in a NH. I chose to place her in a NH. I applied for Medicaid in April. Placed Mom May 1st and she paid privately for May and June. June I confirmed that the caseworker had all the information he had asked for and showed Mom was spent down. She actually was way under the 2k limit of my State. Medicaid started July 1st.

If Mom has any insurance policies with cash in value, the cash in can be used to prepay Moms funeral. Medicaid allows a certain amount so what the cash in doesn't cover you can take out of her money. The caseworker will give you a list of things you need to provide. One is 5 years of bank statements. I was lucky, Mom kept all hers. In my State you only have 90days to spend down the money, get them the info needed and place the person. Its so much easier to get a person placed if you can private pay for a while and then transition to Medicaid.

What I would do first is speak to a Medicaid caseworker to see what the criteria in your state is for Medicaid. Go in knowing exactly where Mom is financially. IMO, even with a Lawyer, you are going to be doing most of the footwork anyway. When I applied, the caseworker ask questions and did the application on his computer. Be aware, that Moms SS and any pension will be used to help offset her care.

When looking for a place, make sure they take Medicaid. I would not depend on the NH to do the application for you. You need to be involved with the process and in touch with the caseworker. We have had people on this forum allow the NH to apply and they have submitted wrong information or not submitted in a timely manner. One person, after 6 months, still hadn't received Medicaid for their parent. As I said, I only had 90 days to submit info needed or the application starts all over.
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Reply to JoAnn29
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I believe you will be told by others you need to make her Medicaid eligible. The process will be easier if you can hire a lawyer who specializes in dealing with the elderly. That will cost some money but perhaps you can shop around. A friend of ours did this for her husband who suffered a severe stroke and the process was greatly facilitated with the help and work by the legal team.

Does your mother have any assets in her name? They will likely need to be less than 2,000 dollars. Even if she has more you can still start the process. If she has some money that could be used towards legal fees. A lawyer should ideally help you find eligible places.

I am sure you will get more solid advice from here. Many know so much more than I do but I believe from all I have learned here I am steering you in the right direction.
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