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My father is in the hospital due to a fall and some other health issues. Long story short, when he is discharged, he will need round the clock care and I'm unable to do this for various reasons. I've been doing some research and I have discovered that Medicare does not pay for Assisted Living. I'm not sure of his financial situation but I know I'm also unable to pay for or even help pay for it.

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FB, re your reply to DupedWife--that your dad wishes to return home.

Please remember that his "wants" do not mean that you have to sacrifice your life to make them happen.

Your needs count as much as his. Dad has other options (long term care); YOU need to support yourself as you have no other options but abject poverty.
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faithfulbeauty Oct 2023
BarbBrooklyn, I agree and definitely can't afford not to work. On a happier note, I will begin counseling later this month.
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Igloo, PACE programs are terrific when there is an able spouse who can devote her/his life to case management.

Not so much when there is an adult child who needs to work.

Nor where the elder is uncooperative.
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FB, how are things today?
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Beauty, it can be quite overwhelming to deal with all this. Please please pls reread the terrific advice and suggestions given.

Try to make this your mantra:
“I cannot provide the safe & secure living space and I cannot provide the 24/7 oversight that he needs for his level of care and healthcare needs”.
Practice this if ya need to because the default position for discharge planner at the hospital or for a NH once dads rehab has ended, is to have you come and get him. Should you do that, their management of him is 100% over with, and all falls to you.

Personally I’d forget any ANY thought of him in AL. He’s not able to do his ADLs. If you got him into one, it will be only be a brief matter of time before you get a letter/phone call that “we so love your Dad but his care is beyond our capabilities and this is your 30 Day Notice on him.”

Really you want him to go into a post hospitalization rehab at a SNF and IMPORTANTLY a SNF that takes LTC Medicaid. And you want to be a little cheerleader to get him to participate and do what needed to be on rehab as long as possible. Being on rehab gives you time to figure out his $, property, debts, whatever, while Medicare & health insurance pays for his rehab. And after his stay as a rehab patient ends once he’s poor enough, he files as a custodial care resident for LTC Medicaid. It is exactly as JoAnn described.

Fwiw NH/SNF get paid like double or triple per day for rehab patients vs to what LTC Medicaid does for custodial care resident . So the facility will be quite happy to have him there as a rehab patient.
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The assisted living facilities in my area are not covered by Medicare.

Wishing you all the best in finding proper placement.
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FB, that program (PACE) is nice, but it requires that someone be the "manager" and there needs to be someone who can step in if the aide calls out.

I don't think you want to be dad's case manager.

Also, is he likely to "fire" the aides and demand you attend to him?

That sort of program works with cooperative elders. Your dad sounds anything but.

Just remember that just because dad wants to go home does not equal that you need to enable that.
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igloo572 Oct 2023
Barb, Ahhhh PACE the latest cute girl in town for doing cost containment for Medicare $$$. We have two in my city. I think they can work to some degree if the person in PACE have dedicated on site family to be in the home always for all the nonPACE time and if they have an experienced partner who is running the program. One very important aspect of PACE is it is a community health Medicaid program so IF your State includes community in how they do the talley for estate recovery, all the cost paid by PACE for you is included.

Our PACE is set up to be a day program where they go 2-4 days a week with transportation provided and spend a fairly long day and all their health care is now funneled either done at the center or to their partner healthcare institution(s). Meals & activities as well. In-home visits if needed. But has to have the on site family “case manager”.

For us, it’s run by the healthcare division of Catholic Charities and they partner with Tulane / LSU teaching hospital systems. CC also has low income housing and congregate living places, so CC can draw from that population to find folks to be enrolled.

If you go onto PACE, your Medicare gets a new # AND the program is designed for you to become a “dual” so on Medicaid for your secondary health insurance. With a Medicare as the primary but they both fold into the PACE system and PACE gives them a new #. If you have an other health insurance, it’s given up and you go onto Medicaid although this has been successfully challenged.** The new # is billed AND all your care is directed by the PACE within their partners facilities IF care cannot be done at the PACE. If care plan gets beyond PACE capability, the PACE deals with getting them placement into a NH and onto LTC Medicaid. Healthcare coverage is limited to the PACE network, which is local, so if you travel, that’s a problem.

*the 1st center was done at an old Catholic Church and nunnery and it drew from CC existing outreach & programs for low income folks. Is pretty fabulous as ton of $ donated by wealthy benefactor & new wf in honor of old wf who a devoted Catholic.
** 2nd center has totally different demographics. Lots of oil & gas retirees with $, great employer based secondary health insurance as retirement perk. Lots of couples, who own and live in their home, where only 1 needs a day program. These folks aren’t going on Medicaid and they most certainly don’t want State Medicaid program being able to do Estate Recovery if they can help it. They aren’t being told what to do for healthcare providers and not able to travel without worry of 1 being uninsured. LSS a group filed a challenge to “dual” requirement and won. So now to enroll in PACE all you need is Medicare & have health concerns that the PACE program can deal with but have to pay a monthly fee. The costs vary but tend to be abt 3K a month.
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FB, how are things today?
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faithfulbeauty Oct 2023
@BarbBrooklyn.
I did speak with the Case worker and she gave me some information on a service that helps people who require nursing level facility care but want to remain in their home as long as they can after being discharged. She said they could come in shifts, but I'm going to speak to her again to verify that someone can be there all the time.
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This is all very confusing. You have to take it one thing at a time. Now, Dad is in the hospital and will be discharged. If Rehab is recommended, send him. This will help u get your ducks in a row.

Medicare is a health plan and Dad should have a supplemental too. But with Rehab the first 20 days are paid 100% by Medicare. 21 to 100 days are 50% paid by Medicare and Dad is responsible for the other 50% unless his supplemental picks up the 50%.

Dad sounds like he needs Skilled Nursing so tell the Social Worker that Dad will need to be transferred to Long-term care because there is no one to care for him at home. It would be an "unsafe discharge". If Dad has savings he will need to pay for his care in LTC, about 10k a month, depends on where u live. When his savings is gone, he will need to apply for Medicaid. His social security and any pension will then go to help offset the cost of care and Medicaid will pay their share. With me, Mom had 20k. This paid for 2 months in LTC. Gave me time to get Medicaid applied for and get them info needed. The 3rd month Medicaid started. Easier to get them in care if pay privately for even a few months.

If Dad has no money other than his monthly income, Medicaid application will need to be started ASAP. Having in home care 24/7 will cost just about what it cost for a NH. Your are working with people who have lives so they get sick, a child gets sick or they just don't show up.

Nurse? An RN can be $40 to $50 an hr., LPN a little less, an aide maybe $20 an hr. At $20 an hr an aide for 3 shifts is $9600 a month. Might as well place him in LTC and no hassle. Thing with an aide, they are not medically trained. They are not allowed to handle meds or give shots unless certified to do so.

You need to talk to the Social Worker/discharge planner and tell them Dad cannot return home.
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Will your father be returning to his home when he is discharged? Medicare will only cover home health services as long as your father needs part-time or intermittent skilled services and as long as your father is “home bound”. Just remember that Medicare will only pay if the care is part-time or intermittent which means less than 8 hours a day and less than 28 hours a week. In some limited situations, Medicare will pay up to 35 hours a week. Your father will pay nothing for covered part-time home health services, but a doctor or health care provider like a nurse practitioner must assess your father in person to order this service and a Medicare certified home health agency must provide the care. Medicare does not pay for long-term care.

If your father needs 24-hour care, then he will have to apply for Medicaid if he cannot pay to have someone come in to fill in for the remaining time during the day. If your father has limited income and resources, he will qualify for Medicaid and he can then apply to a Medicaid SNF where he will get the 24-hour a day care.

The difference between Medicare and Medicaid is that Medicare is medical insurance for the elderly and the disabled. Medicaid, on the other hand, is for people who have limited income and resources (poor people). Your father can get both Medicare and Medicaid if he qualifies for Medicaid.

You can Google Medicare.gov to get more information. You can also call your state Medicaid office to find out if your father qualifies for Medicaid.
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faithfulbeauty Oct 2023
@Dupedwife.. He wants to return home and I understood him wanting to but he is unable to be there without someone all the time. I'm trying hard to find him as much help as possible because I'm not physically or mentally able to do it 24/7.
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FB, reading about your dad's needs, it sounds as though unless he rehabs quite a bit, he will need skilled nursing care, not assisted living.

Listen carefully to what the discharge planners tell you about dad's needs post_rehab. You probably need to be looking for a rehab that also has long term care on the same campus, and one that accepts Medicaid, perhaps after a few months of private pay.
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Did he have a stroke?
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faithfulbeauty Oct 2023
@BarbBrooklyn,
He did many years ago and think his muscles have just weakened over time.
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HI faithfulbeauty, I'm very sorry to hear about your father. As Barb mentioned, your father should be transferred from the hospital to a skilled rehab facility for the next 20 days - you can arrange this with the hospital's social worker - they will set it all up and if there's a specific facility you'd like him to be in, you can let them know. This will give you a little reprieve to then see next steps and what your father is capable of and what level of care he'll need going forward - the rehab can help you thru this and you should be in touch with the social worker at the rehab during his stay so you can begin thinking about future options for him after that.

Wishing you all the best and continued strength ~
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FB, you want to find the Discharge Planning office. If you can't find them, ask to speak to the Patient Advocate.

Please remember that they CANNOT force you to sign for his discharge, nor can they force you to provide him hands on care.

You tell them that you are about to move and that he has no one to care for him at home. Do not cave if they try to guilt you .
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That is correct. It does not pay for ALF.
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FB, when you say he needs a nurse full time, what do you mean?

Do you mean that he needs 24/7 supervision because he tries to get out of bed?

Or that he needs 24/7 MEDICAL supervision due to breathing/bleeding/critical care problem?
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faithfulbeauty Oct 2023
@barbBrooklyn,
As of right now, he can not stand on his own and needs help with everything such as bathing, going to the restroom, dressing. He also needs medical supervision due to medical issues that need monitoring.
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Round the clock care means he will need to be in a skilled nursing facility not assisted living. Assisted living is for people who can pretty much do for themselves but may need some assistance with light housekeeping, medications and food.

That dad needs a nursing home is good news for you because you will finally be free of your dads unreasonable demands on your time and on your life.

If he requires a nursing home and has no money dad will have to get medicaid and it is paid for that way.

Do not sign anything regarding dad getting admitted to the nursing home, otherwise you could be on the hook for said payments.
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FB, if your father is ADMITTED to the hospital for 3 days, he should be eligible for rehab, covered by Medicare.

Start a conversation with the discharge planning office tomorrow about rehab.

Once he is in rehab, he can transition to full time long term care at the same facility if that is the level of care her needs. He can start off as private pay and transition to Medicaid if he qualifies both medically and financially.

Consider where he goes for rehab. In a similar situation, we made sure that we used facilities that would keep mom as a LTC patient on Medicaid after a period of private pay.
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faithfulbeauty Oct 2023
@BarbBrooklyn.
He started physical therapy yesterday in the hospital. As of right now he needs everything done for him and will need a nurse as well all the time. I will be sure to speak with the hospital about next steps.
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correct. If he needs assistance he can try to apply for medicaid.
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Medicare does not pay for assisted living or for LTC in nursing homes or for memory care. The exception is if someone has been hospitalized and then needs rehabilitation in a licensed facility, e.g., stroke, orthopedic surgery, etc. It will pay in full for up to 20 days if the person still needs services and is making progress, and then at a reduced rate from days 21-90.
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JoAnn29 Oct 2023
Its 100 days and 50% of the daily rate.
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