What are the options for Mom (80) if she gets Medicaid?

The big question is Medicare vs Medicaid. Mom was on Medicaid when we had to move her to a nursing home and it was very hard to find one than accepts Medicaid straight out. IF HOWEVER, she goes to a nursing home that accepts both right from the hospital, hopefully they will accept her as a Medicare patient and then put on Medicaid. I had to put Mom into a decent but not my first choice nursing home because she was on Medicaid. When she ended up having to go into the hospital for a week, we were able to have her relocated to a different home where she went as a Medicare patient and after that ran out, they allowed her to stay as a Medicaid patient. Several administrators have told us this is common. It is very rare a place would "kick someone out" after the Medicare eligibility runs out. I would suggest visiting places NOW so you are not forced to make a snap decision. Good luck!

Good luck, hanging!

I would like to move my mom back to her house.
Pay for nursing care (24/7) w/the remaining $ left on her RM, then when that runs out, she may have to go to a NH that Medicaid will pay for.
If my mom outlived her $ from the RM, then I will have to deal with where she will go.
It's all too much right now.
I have been prescribed Effexor from my doctor today for anxiety.
Hope it works.
Thank you for all your help & suggestions everyone.
You have no idea how much this helps me.

Hanging - my suggestion is to get mom into whatever facility that can provide the type of rehab she will need after she is discharged from her hospitalization. Rehab post hospitalization is a MediCARE benefit and Medicare will pay 100% for the first 21 days and then @ 80% up to 100 days.

The great part of having her in rehab is that it creates a window of time to work out the whole "stay or move" & house situation without mom being at the house. Do what you can to be positive about her rehab to keep mom on track with "progressing" in rehab so that she can stay ok for the maximum # of days under Medicare coverage.

The RM is probably going to be a real cluster to deal with. RM's have a pretty specific compliance requirements for the RM to stay in force. If they move from the house, the RM will be called in. I'd be very cautious in taking the remaining line of credit (50K) left on the RM and then mom moves into a NH and out of the house. Doing this could be viewed as a fraudulent gain of funds under the terms of the RM and you as her DPOA could be held accountable. If the house could sell and repay all the principal, fees and settlement charges on the RM, it could work out but if there is a negative balance on the RM, you could face issues in doing this. Understand?

Remember mom is responsible for paying all taxes, insurance, repair, utilities on the property under the terms of most RM's. Taxes are coming due in January for most areas too. Defaulting on any of these, could place additional fees on the RM.

How long has your mom been on Medicaid? You kinda need to find out to see if your mom start date for Medicaid is within MERP rules for Medicaid recipients. If she got onto Medicaid after 2005 or 2006, she's under MERP. All the states now have a requirement (MERP) that if they are over 55 and on Medicaid for LTC and most community based programs, that the state has to attempt a recovery of all Medicaid paid on them from their assets. If the RM gets paid off and there is any extra $ left, it will need to either be used to repay the state for Medicaid costs paid on her OR she will need to spend down the amount as she will be ineligible to continue on Medicaid due to the increase in her assets (her share of the proceeds from the sale of the house left after the RM is paid off). There will not likely ever be any funds left to you as her heir or beneficiary of the trust. So keep this in mind if there are any costs on the house that need to be paid between now & whenever it's sold.

Regarding PACE - this is kinda the new current trend for community based services for the elderly. There is a one by us (Benson Center, New Orleans) and it provides a pretty wide & encompassing range of services & activities. But one thing to keep in mind for PACE, is that family is expected & required to be able to provide any caregiving or support needed when the elder is not at the PACE center or a PACE provided caregiver. If there is not family able to fully do (or family hires & pays for caregivers) whatever coverage gaps exists apart from PACE, then PACE is not going to work for you. Also if the # of hrs needed for care and provided within PACE exceeds a certain # of hours (maybe more than 32/38 hrs a week) then they will be discharged from the program as the cost/benefit is over the formula for effectiveness. They are better served in a NH or other skilled nursing full-time caregiving facility. Ask social worker & nursing staff at the rehab place as to what realistically what mom will need as far as day to day support services to go back to live on her own.

All this is a lot to deal with and your gonna be overwhelmed. Try to break things down and have mom stay in rehab as long as possible within Medicare rules to get an idea of what the options are (or aren't). Good luck and keep a sense of humor going.

Hangingon61: Okay...hope you're successful.

I am not responsible for any of moms debt, but the house will go to me if she died because I am the beneficiary of her trust.
If I want to retain any profit from the sale of the house, I will need to repay the rm what is owed (zest money my mom has used so far, including interest), then of the sale exceeds the amount due, I would get the remainder.
If house sells for $200,000 and mom owed $170,000, I would get $30,000 I suppose.

I thought that was the whole purpose of an RM. They pay and at time of death the houseis sold and they get what they paid out or the house if paid more than the house sold for. Also, Medicaid will put a lean on the house if they pay for her care. You are not responsible for your parents debts. Any assets they have will be split among the debtors. What is left goes to survivors. Watch what you sign, never make yourself responsible for a parents debt.

Llamalover I know that the rm will need to be repaid but I don't have any funds to do that. I will have to sell the house & hopefully the sale will pay off what's owed.

I hope that you aware that the RM has to be repaid when she deceases.

HangingOn - The apartment my mother lives in is HUD controlled. The rent is income based. Your mother can be a PACE participant in her current home. Moving my mother to an apartment was easier and less expensive for us. The rent and utilities and less expensive than utilities, taxes and general upkeep of her house.

My mother also requires 24/7 care. So working with PACE we are able to cover her this way...

She goes to the day center Monday -Friday.
8:00 a PACE provided CNA comes in to get her dressed and feed breakfast
10:00 the PACE bus picks her up and takes her to the center
4:00 she returns home - another PACE provided CNA comes in feeds her a snack and dinner until 9:00
We privately hired someone to be with her overnight.
The PACE provided CNA also comes in from 8-4 on Saturday. The rest of the weekend we cover.
The CNAs help with keeping her place clean and laundry

I feel like we have effectively created an assisted living facility in her own apartment.

My mother house is not a factor for us. She was able to use all the assets from her home to remodel, etc. years ago. The amount of the loan is greater than the house is worth so we will just return the house to the bank.

This arrangement is working for us right now and my mother is happy in her own place.

.

long assisted living i was dealing with the same issue with mom once your mom is hospitalize then after her release if you are tired or stressed out ask for the health care worker she will find a place suitable for mom is gonna be ok just take them around the property in a wheelchair..money it works wonders unfortunetly when my mom get hospitalized i also tell the health care worker that i want her to get rehab so medicare covers 21 days as she gets stronger and go to one you feel confortable with and feel she will be happy...i take ton of stress but dammit everytime i pit mom in rehab i end up visiting her 3 times a day taking her around the property bringing her real homemade food and taking her out like 5 days into it..come on we cant live with out them we enjoy doing for them cant wait till they legalize marijuana in fl so i could release my stress..they are lovely they make your life a living hell..but we love them so much we cant see them sad or suffering all i want to know is when our government is going to realize that they will save money by paying us to take care of them at home since we cant function like normal people and live a happy everyday do as we please and come and go as we pleased life..wake up...assisted living is a business there is no one in this world thats gonna take care of our love ones like we do..we need to stand together to change laws in this country..its bs gov spents 6 to 10 k a month to put one parent on assisted living plus meds plus bs..give me 3 k a month thats a saving of over 50 percent and they are actually love ...

Hi Hangingon, in our area there are a couple places that are Medicaid only, but many are combined (with some private pay and some Medicaid beds.) They are a lot nicer than nursing homes were when we were younger.

While your mom is at rehab, this might be a chance to check out a few. If you find any that seem nice, you can ask them to put your mom's name on their waitlist (if they don't have immediate occupancy.) That way, if you are not happy with the place she begins with, you'll have other options lined up. (You can stay on the waitlist indefinitely, so if they have a space for your mom and you don't want to move her yet, just ask them if they can keep her on the list and call you the next time a space is available. ) In our family we are worriers and it helps to know there's a plan B when we're making big decisions like that.

Doubleu you mentioned you were able to get your mom into a senior apartment.
Who pays her rent?
I can't afford to pay any rent for my mom, I struggle to pay my own at times.
So if my mom has to stay in her house, would the program you mentioned (pace) still apply to her?
Also you said your able to care for your mom in her apartment, do you preform the (nursing care) yourself or do you have nurses stay w/your mom?
My mom can't be left alone so she would need nurses 24/7.
This is something I'm learning that Medicare or Medicaid will not pay for.
I wish I could convince my mom to sell her house, take any remaining equity or what's left of the rm & move to assisted living but I don't know if that would be allowed (by the benefits that would be available to her because she will sell her home)..
Would an elder law (as someone else mentioned-thank you) attorney know all this??

My daughter works in a nursing facility and says the Medicaid patients are not treated any different than private pay.

I had a similar experience with my parents (both at the same time). It was overwhelming but we made it through (I wrote a how to book on finding a nursing home in a crisis with my sister). I think you are getting great advice about deciding first if you mom really needs to go to a nursing home after rehabilitation. She may not need one. In my experience, getting her help to pick a place where she would go if she were eventually unable to care for herself is a great idea. Now that she has had this scare, she might even work with you to prepare to down-size, etc. and at the very least make sure you have all the legal documents in place.

First step: have a conversation with your mother's doctor, not the ER doc who is only involved in her care for the brief time she's in the ER. Get as much info as they can provide on her prognosis and condition and the type of care she'll need. Make it very clear that you work (I assume) and cannot be her full-time caregiver.

Since she's already on Medicaid, that's a big hurdle that's already been overcome. DO NOT assume that any skilled nursing facility that takes Medicaid is going to be a 'bad' one! Every county-owned nursing home takes Medicaid and, in our area anyway, they are on par with the best in terms of care. They're just not as fancy in the decor department.

Also, I don't know what your state's Medicaid laws are regarding assisted living, but if it's covered, see if mom can regain enough independence to get a placement there.

As for the reverse mortgage...go see a qualified elder law attorney ASAP! Even though it's not a huge amount of equity that's left, it's worth a few hundred dollars of a lawyer's time to talk through the options.

Your mother's situation sounds similar to my mother's. She had a stroke and was no longer able to live alone - she also had a reverse mortgage on her home, but no remaining assets from it. We were able to get her on Medicaid. Then we signed her up for the local PACE (Program for the All-Inclusive Care for the Elderly). It may be called something different in Illinois.

PACE provides a day center, lunch, doctors, nurses, PT, OT, SLP, social worker, home healthcare, pharmacy, and transportation. I know they also provide laundry services, frozen meals and maybe other things I may not be aware of. This program has enabled us to care for our mother (in a senior apartment-her house was too big/expensive to maintain) without putting her in a nursing home.

Also, just because a doctor said your mother should be in a nursing home, doesn't make it so. Give your mother a chance to recover and regain some independence instead of automatically looking into nursing home care.

1. Remember that the ER doctor saw your mother only for the emergency. Look for more accurate advice from the doctors who are seeing her while she's in the hospital, especially the orthopedic doctor who's assessing her post-fall and for future fall risks.

2. Consider the age of the doctor. In my experience, it's not unusual for younger doctors to first consider a nursing home, after only a brief assessment of the patient, generally in a bad condition.

It took me a while to realize this and I did so only after a bad experience with a younger doctor. In retrospect, I realized that I had experienced this more than few times before, so now I try to find older doctors.

3. If you can get a geriatric doctor involved while your mother is in the hospital, do so. You can ask the charge nurse how to accomplish this.

4. In the meantime, get a list of potential placements from the discharge planner, research Medicare.gov to determine which might be the best facilities(Medicare rates them by various categories), then call the facilities and ask for a tour. Lunch or dinnertime are busy but give you a good chance to see how much staff there is. But also ask about the patient to staff ratio. It's very important.

5. Research online to see if there are any ombudsperson agencies in your area that deal with nursing homes and complaints. Contact them and ask if there are any with bad reputations.

6. If you do feel and the ortho doctor supports that your mother can live at home, start making arrangements for a medic alert and Meals on Wheels, and ask about home care nursing and PT after she returns home initially as well as thereafter.

A medic alert pendant or button is mandatory for someone who's fallen and is living alone.

Good luck with your search, but remember that these next days and weeks may seem overwhelming. I find it's best to make a checklist of everything for the short and longer term future, so I don't forget anything, as I did once and ended up having to move my father from one place to another.

You could also be looking at a small group home for your Mom, depending on her physical limitations. In my parents' town, there were a number of them that accepted Medicaid for treatment/care and when we visited some, almost all residents were in wheelchairs, so they are able to take on people with limitations. The difference, it seems, is that they do not have more than about 10 residents living in the home, which is generally a private home. So it's more like 'family' atmosphere. Often owned by an RN or family with background experience. They are still licensed by the State Health Dept and all that legal stuff. And if Mom is still pretty high functioning, she could be eligible for an assisted living facility that provides higher levels of care. Generally, those have a waiting list for Medicaid residents, and first on the list are private pay residents already living there, who are running out of money and becoming Medicaid qualified. So she could perhaps be admitted anywhere as a private pay, use the resources left from her home, while on a waiting list for a Medicaid eligible bed. The best way to figure all this out is with the help of the hospital social worker, or SW at rehab facility she were to go there, and then by consulting with the admitting people at whatever longer term facilities you are considering. I learned with my Dad, who eventually was on Medicaid, that you remain in charge of where your Mom goes and that Medicaid and the caseworker assigned to her, is working for YOU, so if she is already on Medicaid, you could also be consulting with her assigned caseworker. Since they follow clients at many different facilities, they can lead you to 'good' places. And when you ARE considering a final place, there are ways to contact your state authorities...by starting with the State Health Dept and finding out who licenses NH and Assisted Living facilities, to check on any complaints filed about the places you are seriously considering.

If she needs 24/7 care then ask nursing homes around your area if they will accept Medicaid patients. Of all the millions of people in a nursing home, only a small percentage have severe problems. Do your homework and visit in person the facilities at different times of the day and night. Look for cleanliness and caring staff and staff to patient ratios. You can find some place for your mother. Merry Christmas!

if only one MD has said your mom needs to be in a nursing home, you may want to contact a geriatric social worker, eldercare RN, PT, or an MD who specializes in geriatrics to get a broader diagnosis to be sure what the next best step is for your mom. At 80, she could still have a lot of life left in her! Other options may prove more financially sound and appropriate such as adult day care, Meals on Wheels and other geriatric services offered through your state.

Therese, what do you mean " come after them"? Adult children are not responsible for the care of their parents. Unless they've been draining mom's assets for their own use.

Here is a link to the FL2 form in my state of North Carolina..It is my understanding that it is one of the hurdles to qualify for skilled nursing care under Medicaid.
http://info.dhhs.state.nc.us/olm/forms/dma/dma-372-124-ach-ia.pdf

Grace + Peace,
Bob

You said mom is already on Medicaid. It may not take much effort to get her into a nursing home. I can't comment on the equity remaining in her home, although the nursing home itself can't "take it." Once "medically" approved for skilled nursing care, the gubmint (and state) pays almost all of the nursing home fee through Medicaid...In my state the nursing home resident must pay all of his/her income except for $35 a month to the nursing home as his/her part of the cost of care...(my wife has $750 a month as only her only income from Social Security and that goes to nursing home.)

You should have a choice as to which nursing home she enters, if approved for nursing care. You may want to google on "FL2" which is a hurdle for getting approved for nursing care.

You may want to engage an elder care lawyer for assistance.

Grace + Peace,
Bob

if she lives with a child could they come after them for the money?

If mom is in the hospital for 3 days, she'll be eligible to go to rehab afterwards. March yourself directly to the discharge department TODAY and start the conversation about where mom will be sent for physical therapy after she is released. Please realize that if she doesn't yet have a discharge date, they really won't be able to find you a bed NOW, but they can advise you on possibilities and you can go and look at them and rank them in order of preference.

We did this when mom was in AL, fell, broke her hip and it was clear she was going to need rehab and THEN permanent NH care. We worked with the discharge planning folks, telling them about mom's finances so that they could tell us about places that would accept private pay first and then let her stay on as a medicaid patient. Ideally, you mom goes to rehab at someplace that will take her with her Medicare payment during rehab, private pays with her RM funds and then is accepted as a Medicaid patient.

When mom is on NH Medicaid, her Share of Cost will be her SS check and whatever other income she has (unless she has a living spouse). She will be allowed to keep a small Personal Needs Allowance (betweeen 35 and 90$ a month, depending upon what state she's in). Because all of her needs are being taken care of in the NH, money will be spent on haircuts, replacement clothes, etc). It seems like a reasonable arrangement to me, when the Fed/State is picking up several thousand $$s a month for her care.

I'm not sure how getting her a small apartment would work if she needs full time care. That doesn't seem like a very good plan. You'd need to pay for 24/7 aides, unless Medicaid covers that in your state.

Get the 50000 left from the reverse mortage ,,get her in a small apartment ,, Or use the money to get her in a nicer nursing home,,If you put her in one they will take the house and her SS,, she'll get 50 bucks a month,, you have to move fast before something else happens