Medicaid payments have been delayed for months. Admin is evicting mom on basis of "beyond their care" masking non-payer status. They're attempting to move her to a dementia unit at a less desirable facility even tho they can provide that care themselves. She has very mild dementia and aphasia from an old TBI. She is cognizant of COVID and why we can't see her. Yet, administrator told us they are moving her soon and we can't even go pack up her belongings. A while back, they implemented questionable actions such as waking her at night to use the bathroom (she wears adult diapers) and sending her to ER a lot. ER sends her back w perfect bill of physical and mental health each time. Then they assessed her w dementia without our knowledge; yet she's no worse than other residents. This seems abusive and federally illegal, but NYS seems to have their own rules. The Aides tell us they love mom, she's sweet, no trouble to them and don't understand why admin wants to move her. No one, including State & ombudsmen willing to help, saying we have no recourse. We don't have money for lawyer. Mom has been at this facility for 3 years, she is 93. Any ideas of keeping mom happily where she is?
It does seem as though there's something going on with the administration, perhaps b/c they don't want to wait for Medicaid to pay. What's the situation there? Did you have anyone help with the Medicaid application? Are there aspects that you can address?
I might ask to speak with whoever handles Medicaid qualification and interaction on behalf of the facility to see what the real bottleneck is.
If I were to guess, as she’s had a yo-yo of runs to the ER, that’s she’s been presenting to have had TIAs & those along with her aphasia are the issue for her care. Or maybe mini concussions from old TBI.
TIAs can be kinda subjective as to whether it happened but some facilities either to be on the safe side or do not have staffing to closely monitor plausible TIAs for a day or 2 always call EMS to take them to the ER where they get evaluated, perhaps held 24/48 hrs for observation & then return back. They stabilize, get super rehydrated, perhaps oxygenated too and get a clean bill of health to go back nicely refreshed to facility.
If she’s been there 3 years, there have been numerous care plan meetings held for her to which dpoa gets notified of to participate in. What’s been the upshot on these? It could be that they think a major stroke is looming or she needs aphasia care and want her in a facility set up for these. Could this be it?
Regarding Medicaid, if she’s been there 3 years, was she always on LTC NH Medicaid? If so, and she has been paying NH her required copay, then I bet the problems with Medicaid payments are a medical eligibility issue not a financial eligibility problem. Dealing w/medical eligibility is kinda out of the hands of Dpoa as it’s the NH that’s going to need to submit chart, lab, PT, ST reports to the state. ((My mom had medical eligibility issues (RXs and co-morbidities stuff) and outside of my signing off for the appeal hearing to happen, the NH did all; and it was settled & ok before the hearing was scheduled.)) If she’s needing some kind of TBI, TIA, aphasia care, it may have been determined by Medicaid that she needs to be in another facility with staffing for that level of care for Medicaid to pay.
OR was she private pay & finally spent down assets to apply for Medicaid, so she’s been “Medicaid Pending” and not yet approved? If it’s this, then it’s imo a financial eligibility problem. There would have been correspondence from the state to her & DPOA on if she had a items missing or in question that needed answers or documents ASAP. She also would have to pay the required copay of almost all her SS $ and any other mo income to the facility as well from date application filed. Or has she had a change in assets that Medicaid discovered?
Financial is all on her or DPOA to provide quickly whatever state needs or will be ineligible. If you don’t, medicaid denied & there will be a hefty bill due by mom or whomever NH can find to pay for months Medicaid denied. NH might have her stay if copay high & care needs do-able if have open beds; or can try to get family to move her back home; or send her off to ER and then refuse to take her back; or do a lateral transfer to another NH more Medicaid lenient. But there’s only so long unpaid NH bill situation can go on before NH gets state to step in & files a ward of the state / guardianship action.
So is the problem medical or financial eligibility?
Due to Covid concerns, facilities are on super lock down. Families flat cannot just come in to visit. Folks are looking thru windows or scheduling iPad chats to see parents or spouses. There was yesterday a foto of a 80+ hubs who hired a cherry picker so he could see his NH wife in her 2nd story window, just heart breaking. Your carping abt not being able to pack her belongings, well, looks so out of touch with reality... just saying imo
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The facility we chose for Mom 3 years ago at age 90, has 3 levels of care and they initially stated that as Mom’s needs increase, they would be met without moving her. However, once her money ran out and Medicaid payments continued to be delayed, the facility started implementing questionable actions. One, they started sending her to the ER frequently only to have the ER questioning why and returning her with a perfect bill of physical and mental health and two, waking her frequently at night to use the bathroom. She became incontinent and wears adult diapers after hip surgery 4+ yrs ago. Both the ER trips and disruptive sleep have stressed her and made her a bit disoriented. Eventually, they tested and diagnosed Mom with dementia without our knowledge. Now, even during COVID, they are telling us they’re moving her to a (less desirable) facility with a dementia unit even though they can provide that level care themselves. And yes, both facilities are in lock down! Her memory for nouns is pretty bad and she suffers from aphasia due to an old TBI, but by our observation, she is no worse than other residents and better than some. The Aids who take care of Mom have reassured us that they love my mother, she is sweet and is no trouble for them. It is seems to us, everyone who knows my mother, that these actions by the administration is money driven, the result of Medicaid taking forever to kick in. On paper, the facility’s administration is claiming her needs are beyond their care due to dementia. This is confusing to us since some residents obviously have Alzheimers. Also, New York State seems to have their own rules and doesn’t necessarily comply with Federal laws (according to the few ombudsmen we’ve consulted). I feel we have reached a hopeless dead end. We even contacted the Health Board of NYS, who offered nothing proactive or positive. The less desirable facility is not appropriate for Mom, but we feel we have no recourse short of winning the lottery or making enemies with the current facility. Mom, once a nurse and devoted church volunteer, is 93 and doesn’t deserve this. Is there no hope of keeping mom where she is happy and comfortable?
on the bright side: Mom is getting "outside" visits. During one of which, the Aids brought her out onto the balcony all bundled up and my brother sang happy birthday to her.
Better worded, the facility might be wanting her out b/c she is on Medicaid. Because private paying clients pay more $$$ versus Medicaid Long-term Clients. Did you contact your State or County Medicaid office? The county Medicaid office determines Medicaid eligibility and resident co-payment ...
Usually a facility --that wants more money (by opening rooms for higher paying private payers)) -- will compile anything possible that legally fits into federal parameters to evict/transfer.
The most popular are:
1). No longer able to provide needed care; Facility no longer meets resident's needs
2). Resident is a Danger to others.
Is it possible that facility is wanting to inspire you to remove her? Don't remove her, don't agree to a transfer. The facility is legally mandated to send you, in writing, a notice about her transfer that tells you the date and place to where she is to be moved.
Evicting due to Medicaid non-payment is unlawful. Eviction due to non payment of salon services is allowed. BUT a legitimate dementia assessment is normally covered by Medicaid, since it involves a CT scan, the social workers request to remember blue, ball, shoe is worthless. So you must obtain invoices for each billed item. And you need to look at her medical records to discern if she truly had a legitimate Dementia eval.
When your mother was sent to the ER, up until recently that was an old tactic to get more money from Medicare, it was a way to get higher payments for the rehabilitation wing. BUT in your case it could be their way of building records to get rid of her.
Medicaid payments are between that facility and CMS; if the facility stated in writing, that Medicaid non-payment, is the reason for the eviction, then you will need to contact your local county Medicaid office, to find-out what is happening to those Medicaid payments.
Also, each month, a facility is mandated to send a monthly itemization of each billed service for that month. Medicaid doesn't cover telephone, TV,etc. To whom were those private pay billings mailed? Find those invoices.
If her current facility has a memory care/dementia unit, the there is technically zero medical reason to transfer her. Which equates to the administration wanting that room opened up for a private paying client who is needing to move-up into long-term care.
In our facility they start verbally threatening evictions only for Medicaid residents usually 4 weeks prior to their 6 month Medicaid review.
Usually each month an invoice of that month's billed items are generated for each resident. When she was private pay, to where were those invoices sent?
Google backdoor Nursing home evictions, for examples of tactics utilized to get Medicaid patients/residents to move out.
As mentioned, your next step is to request her entire billing record. ALL invoices from day one.And your other next step is to contact your county Medicaid office, to find-out what is happening with those Medicaid payments.