How do I get my mom out of a nursing home and bring her to my home (9 hours away from there) and transfer her Medicaid, Medicare, and SSI?

Grandma1954 July 31, 2023 7:55 pm
You have nothing in your profile indicating what problem mom has.
Why is she in a "Nursing Home" (aka Skilled Nursing facility)
In reality if she is in a Skilled Nursing Facility she needs the medical care she is getting.
Are you prepared to meet those needs in your home?
Can you do it safely?

Do you have POA?
If you have POA then you can begin the transfer process. Talk to the Social Worker or the Discharge Planner at the facility.
The Social Worker can also put you in touch with the people that you need to talk to to make sure that everything is transferred properly.
They will also set up transportation.

If you do not have POA then you can not transfer her to your home without the approval of the POA.

And you can not just sign her out and take her to your home.

How old is your mom? How did she end up in a nursing home? Why do you want her to move in with you? Knowing nothing about your situation, I will say that caregiving is very difficult. I would think very hard about whether this is really the right thing for you or not. I'm sure you have really good intentions, but there is a lot to it and burn out can happen very quickly. Do you have other siblings? Husband? Children? Grandchildren? Your life will change in a BIG way if you bring your mom to your home.

If you are not her PoA or legal guardian, this probably won't be possible (although rules/laws vary by state).

I agree we need more info to give you the best guidance.

Please think long and hard about doing this (if you're even able)... having to care for someone 24/7 can be very physically, mentally and emotionally demanding, stressful and limiting for you. You won't be able to get paid for it, especially if your Mom is on Medicaid. Medicaid will barely cover enough hours be week to be helpful to you. All the rest of her money will go towards the in-home care (see Elder Waiver for your county).

Will you be able to afford the cost of feeding/housing her since the majority of her money (SS) will be taken by Medicaid?

If she's not mobile, how will you get her to appointments? Changer her if she's incontinent (and unless she's very tiny this will be strenuous several times a day).

You could try talking to her case worker (if she's on Medicaid she will have one). Unless you have another person who will be helping you for the long haul, and you're both strong and in good health, moving her in with you won't be a walk in the park.

We really need more info. Her age, does she have Dementia, why do u want to bring her to your home. Why not just move her to a facility closer to you.

If Medicaid is paying for her care in a NH, that does not transfer to a home situation.* Medicare is just a change of address. Social Security Security means a new acct# to direct deposit to. If Mom has Dementia, then u will need to be payee and POA is not excepted.

*Medicaid for NH care and Medicaid for health insurance and in home care all have different criteria. Medicaid is County based. So you need to talk to Medicaid in your County to see what can be transferred over from the County that Mom resides in. She maybe able to continue with the health insurance she receives. You may be able to get some "in home" help or even be paid to care for Mom.

Changing to in home Medicaid will only get you a few hours of professional help per week and not even a full time 40 hours. The rest of the care will be on you. Since she is already on Medicaid, insurance will not cover the transportation. That will also be at your expense. The paperwork is feasible to change. The physical care and transfer will require some thinking.

Please don’t do this. It’s more than most people can handle, and her needs may surpass your capabilities. The paperwork alone will take plenty of time. Being responsible for her 24/7 care will leave you with no life.

Good luck, you’re going to need it.

Well she is 91 years old, has early dementia, I have a Medical and financial POA, I have two brothers, one lives 7 hours away from her, he is 70 and told me that since I am the only woman in the family and the oldest one the duty falls on me, the youngest brother 61, was living with her for a year without paying rent or bills or anything and eating from her food stamps, all of the sudden he left the house like a thief, at night, didn’t tell anybody and left her alone in her house so that is how she ends up in the nursing home because she didn’t want to live with me. It is hard for me at 71 be driving every month or two to visit her or take care of some things like especial doctor visits. The nursing home requires some one from the family to go with her to this visits. So that is the situation.

And moving her into a closer facility will be hard for her where everybody is English spoken around here and she only speaks Spanish.

Call Social Security, Medicare and Medicaid and find out what the steps are and in what order they should be done. A local social worker might also be able to help you understand what to do. Depending on your Mom's condition, be realistic about whether you'll be able to care for her in your home. Should she go to rehab for a short time to get physical and occupational thereapies and to regain strength and capabilities? Maybe this is being done in the nursing home. All the best to you both.

Sorry, but are you cuckoo for cocoa puffs? After reading all of the horror stories on this site about home care and people begging for ways to get their LO into a facility, you want to take her out of the facility and into your home? She's 91 freaking years old. She isn't gonna get any easier to handle.

I noticed your brothers are not offering to put her into their homes. There is a lesson there.

Bluerose2344: Please amend your plans.

Hi
First of all hang in there! Where there’s a will there’s a way. I would ask a social worker or contact your local state Medicaid, Medicare and SS offices . Medicaid if transferred to your state will cover in home care for your mom all day as well as respite hours . Each state has different rules. I would also rec a hospital bed for her because of her age which if approved for Medicaid her local Medicaid rep will order for her as well as other supplies. This process is usually a month but again depending on your state . Medicare does not as far as I know offer on home care. Also Medicaid will pay you to tajd card of her but just be ready because it’s back breaking work. Good luck to you. It can be done . 🙏🏻🙏🏻

you will deeply regret taking her out of care. Why are you doing it. If it’s guilt /burden because of the distance, move her somewhere closer. Is it financial? Seek advice

I am taking your question at face value....

Can your Mom sit up? If not, can she lie down. Does she use diapers? How often does she go? Is there a time when she is less likely to empty her bodily functions (like at night when she is sleeping)? There are services for senior transport if you are questioning whether she will be able to survive the ride in the car.

About Medicaid, Medicare and SSI. You may find that those programs will not pay as much if you take her into your home, even though Medicare has a "home health" benefit. A better option would be to find a facility near you that does take Medicaid, Medicare and SSI and place her there. Medicaid rules are state specific. I would talk to someone in SHIP (State Health Insurance Program) and see if the benefits differ between home health care and for her to stay in a nursing home and do a cost comparison. Each state has their own SHIP program which is up-to-date on the individual state rules. There is no charge for their service and they are supposed to be completely unbiased. Texas' SHIP website: https://www.shiphelp.org/about-medicare/regional-ship-location/texas

They can also get you to the right agency to answer your questions about moving your Mom's benefits across counties.

Good luck and best wishes.

I’m going to approach this from different perspective as one who has moved my bilingual mom from Nh#1 to NH#2 in TX, dealt w/TX Medicaid system for her & MIL and have a dear friend who is dealing with a elderly neighbor seemingly abandoned by errant druggie son. First of all, YES! you can move your mom, but I would not, WOULD NOT ever try to move her into your home with thoughts that there will be oodles help from TX Medicaid or DHS system. There will be promises but it will not happen or will be a waiting list.

For community based program to be able to actually help, imo you need to be in a county big enough w/demographic & economy vibrant enough to push for these programs to be done. Imho unless you are in Ft Bend, EP proper, Bexar, Harris (& somewhat Waller), Tarrant, Dallas (& somewhat Rockwall & Kaufman), Galveston (mainly the isle), Travis & parts of Williamson, there will not be availability. For the other counties programs will be on waiting lists. TX did not take expansion and that has seriously affected programs. Either you provide care for free or you personally pay for it or your mom does.

So imo she is imo best off to stay in her current Long Term care program. Because if you do anything to take her out of long term care / skilled nursing care, she will cancel out of that program entirely and it will be beyond hard to get her in again without a lot of drama. Imho what you want to do is get an LTC Medicaid inter-county transfer of care done and this has to be facilitated by Medicaid caseworkers; you as her POA can request this but ultimately if you want the State to pay, then the State does the transfer*.

* transportation costs are a grey area. Really just assume you personally along with a friend to share the drive are driving her within the single day from old NH to new NH.

It is going to be a real ballet folklorico to do but can be done. Just how difficult imo depends on:
-1. How is your mom in this NH? Is she there as a LTC Medicaid custodial care resident? So mom already though LTC Medicaid application process and eligible? Do you have a copy of her LTC Medicaid eligibility Notice & her case #? If so, thank goodness! If not, you as her POA need to contact caseworker get a copy & asap.
Next ? so how is this NH being paid her required LTC Medicaid copay? Is mom current on her NH bill?
You need a statement from this NH showing “current”.
Next ? what precisely is going on with her income?, like has mom made this NH her representative payee for SSA income? That will need to be changed and you will need cooperation with current NH to do this and need to get your mom to be able to interface with SSA to request this, as SSA does not recognize POAs.
OR
has brother absconded with her $? Gawd I hope not!
OR
are you as POA in control of her checking acct which gets SSA & aother income? So writing a check to NH for her Medicaid required copay? I hope it’s this as way easier.

OR is all this new info to you and mom is not on LTC Medicaid or you don’t know if she is, and you don’t know what is going on for her financials?? If this is what is happening, post that ASAP cause way different situation to even start to deal with.

-2. So moms approved for LTC Medicaid and you have a current zero balance statement from her NH. You will need to find open & available LTC Medicaid bed in your city / county. So you will have to get out and visit NH and find like 3 that actually have open beds.

I can tell you that it’s very likely these will not be ideal. That why they have open beds. No es importante por que not es final. It’s all about having someplace for mom to be able to immediately transfer to. It’s a “butts in bed” needed situation. (I did not have that problem, I knew which NH I wanted her moved into and waited till they had an opening)

- 3. Current NH will need to provide info to their Medicaid caseworker & the potential new NH as to your moms level of care.

continued in page 2.

Continued:
- 3. Current NH will need to provide info on moms level of care to their caseworker for inter county transfer documents & likely to new NH to determine IF new place can meet level of care. This is a Medicare requirement.

Ideally done in person but via Zoom?, or paperwork review? New place may require an in person assessment done at your expense. When you are looking at new NH, clearly tell them she is moving from another NH and ask how they do transfers. Somebody somewhere should know how these are done.

Note: For my moms NH#1 to NH#2 move in the same city, I as POA signed off document to allow for assessment & new NH#2 sent over their assessment team of RN & SW to moms bedside to evaluate & look at her chart. They called me from her room to tell me all ok, then put mom on the phone. I went over that day to sign paperwork to start the transfer & sent old NH certified letter as to when move would happen. I timed it to be right after beginning of next month so moms incomes both came into her checking account so both NH could get paid to the penny exact copay requirement as per LTC Medicaid. Being OCD on this with NHs this can matter as their billing offices tend to be slackers. One thing that I had no idea about was moms drugs. New NH made it very clear that I had to- HAD TO - be sure to get all of mom’s medications. Like take ziplocks to get all. These are in 30-90 day blister packs locked at the nurses station. If you don’t, neither Medicare or Medicaid will pay for dupes, so you as POA will have to private pay for them. Could be serious $$$.

4. New NH has a caseworker assigned to it. You want to find out who it is and contact them. So that you have a way to contact both the caseworker for the old NH and the new NH. This is critical to getting transfer & keeping her eligibility.

5. Right now, if you don’t have your address used for contact address for LTC Medicaid go ahead & have that done. If it’s currently going to mom at the NH or to your brother, that needs to stop. So much of LTC Medicaid paperwork is super time sensitive.

6. Health insurance. If you can find out what health insurance format her current NH is using. I know this is info overload but this is mucho importante: if in a NH on LTC Medicaid, that program is NOT health insurance. Her health insurance is Medicare & Medicaid & she is a “dual” Texas has moved how duals get coverage to be into a MCO (managed care organization). MediCARE & Medicaid get folded into a MCO plan in the State. Ideally you would want her to stay in the same plan. Molina and Superior are 2 bigger ones. Not critical to do this; just easier for exchange of health chart info if it stays the same.

**********
Mom has a home? That’s what it sounds like.
if so, under TX LTC Medicaid rules, she can continue to own a home as an exempt asset BUT due to required copay will have zero-none-nada of her $ to pay any costs on it. Right now you probably have alot of other things more pressing to deal with. Maybe have the utilities shut off and secure it as best and economically as possible & deal with it later.

My friend is dealing with an adjacent blighted property, the lady is now in a facility but the son - who has priors - comes by to use it as a party house. Little that can be done. It’s seems to be a race as to whether it’s eventually a foreclosure or delinquent tax sale. She thought about buying it but did a title search and Sonny appears to have gotten his mom to have used it as collateral so has liens as well. You may want to do check with tax collectors office & do a title search before you get too involved. Buena suerte!

All you have to do is contact SSA to let them know you are moving her, the new address and they'll be able to tell you when her check will resume going to her account instead of the NH. Then notify NH she will be checking out. If you are already responsible for paying nursing home out of her bank account, you'll really just be reporting a change of address to SSA and you just stop paying NH when you ck her out. To avoid prorated month owed, simply move her on the last day of a month.

By all means, be prepared for any kind of help you are going to need at your house if she has medical/health issues or mobility issues. Gather equipment that you'll have to have to meet her needs - bedside toilet, maybe an adjustable bed, etc. Can she make a 9 hour ride in your car? Will you have to break the trip up into a 2 day thing or more so she's not uncomfortable? Will you need a medical ride via an ambulance or medical transport so that she can lay down? Get all your ducks in a row.