Financially I can't care for Mom. So what happens if I refuse to accept her from nursing home discharge?
My 90-year-old mother, who suffers from dementia, entered a rehab/nursing home facility after hip surgery due to a fall. They have attempted rehab, but I am afraid she will never be able to walk on her own again. She’s eating just enough to stay alive (mostly with nutrition drinks they give her).
Her 100 days of Medicare is up and they say she must leave. They claim not to have permanent bed space in the nursing home. Prior to the fall my mother lived with me as she has no savings (only social security) and I have no money to pay for assisted living or other residential care. I am renting and my hours have been cut at work. I had someone come in to 'watch' my mother several hours a week and that was not enough. I need to work and can't afford round-the-clock nursing care for my mother. She has not recovered well (she no longer walks) and her dementia is worse.
My question is this: what happens if I refuse to take her out of this facility? I am unable to care for her and I am in a panic trying to find an assisted living or nursing home facility. I was hoping that she could remain where she is since it is also a nursing home. Any advice would be appreciated.
There are several places where you can turn for help in resolving the difficult dilemma of finding a place that can provide the care your mother needs. But the search may require some time, effort, and patience.
It sounds like your mother may qualify for Medicaid. You can find out more about her eligibility and apply for coverage at Medicaid.gov. Each state provides Medicaid coverage for the full cost of living in a nursing home for those who qualify for the program. However, it’s important to keep in mind that while some states provide Medicaid coverage for assisted living, others do not.
One quick way to compare assisted living or nursing homes in your area is by using Caring.com's local eldercare directory, which you can find here. It includes contact information and a description of capacity, whether a facility is nonprofit, and displays Medicare's five-star rating.
There should also be a discharge planner or resident and family advisor at the current facility who may be able to offer advice about affordable nursing homes, assisted living, adult day care or other local resources. If you don't find the information you need through them, contact your local nursing home ombudsman, which you can find through the national group at www.ltcombudsman.org.
Finally, call the local Area Agency on Aging, which you can again find through the national group website at www.n4a.org.Representatives there should be able to refer you to available resources for temporary and permanent care and housing for your mother.
It seems to me that this is what Medicaid is for. It sounds like she should certainly qualify. Have you looked into Medicaid? Your local Social Services would be the place to go. Good luck.
If the nursing home says they have no openings for long term care, you may need to move her to another facility. One thing for sure, they cannot kick her out until you have a plan in place for her. Don't let them bully you into thinking that, but start the process for Medicaid immediately. It's a horrid process to go through, but given she has no equity it should be fairly straight forward. It took 2 years to get my Mom approved for Medicaid, but they cannot force her to leave in the interim - I believe that is a law. Good luck!
I agree that Medicaid benefits should be explored. My mother was 85 years old when she broke her hip, and began showing signs of dementia while in rehab. I attempted to bring her home and care for her, but she landed back in the hospital. The found that an infection was causing her to have delirium in addition to her dementia. (I never knew there was a difference until then.) I would recommend that you have her regular physician examine her BEFORE you place her in a nursing home facility. There may be an underlying cause as to why she has stopped eating. That being said, I will give you the same advice I was given prior to putting my mother in a nursing home. Do a lot of research on which home is best suited for your mother's condition and if no bed is available, try to wait until it is. And always remember, any nursing home is only as good as the amount of family participation provided. Even with daily (sometimes twice) randomly timed visits and constant communication with staff, the first nursing home we chose still managed to injure my mother so badly that she was dead from her injuries within eight months. By the time she died, we had moved her to another nursing home, but it was too late for her. Unfortunately, this occurred in Louisiana where the laws are on the side of the nursing homes and I have discovered that what happened to my mother was not uncommon. Try to get her doctors, nurses, case workers, etc. to recommend a facility. They didn't seem to want to do this in our case, but with a little pushing and promises to "keep it off the record" I was able to find out a lot on certain facilities that looked good on the surface but had an "underbelly" that I wanted no part of. My prayers go out to you. Best of luck.
This is definitely a case for medicaid funding; exactly what medicaid is for. The administrative staff at the nursing home SHOULD HAVE all the info you need to get you started in the application process and SHOULD help you. If not, then i would be very suspicious of the level of credibility and professionalism at this home. In fact, they SHOULD HAVE helped you apply for medicaid funding when your mother was initially admitted so she would have that option in place when the medicare days ran out.
The local/state department of aging can also help find an available "medicaid" bed somewhere, even if it's only a temporary location until something closer to you opens up. And remember that while the application process may take months and the home will not receive any payments until the medicaid funding is in place, I am reasonably certain that they will eventually receive retroactive payments from medicaid back to the date of the application.
The home your Mother is currently in, can move her without your knowledge or permission, if they so desire. Law?? You've got to be kidding! Who said nursing home administrators followed law? My Father was released from the hospital following a 7 day stay for congestive heart failure, after the facility nurse refused to allow me to call the facility Physician to see Dad for excessive edema in his leg, stating it was level 1 edema, that she was the nurse, and she was the only one authorized to call the physician. I called the paramedics who removed 6 liters of fluid off of his lungs. Dad was placed on Hospice care prior to his discharge from the hospital. That was my introduction to congestive heart failure, and I could have stopped it if I would have followed by instincts.
The social worker at the hospital and the nurse at the facility in which Dad had been a resident, arranged for his return trip to his original facility without consulting me. I dutifully went to the nursing home and paid the successive month's rent as I was told. I received a call from the emergency room doctor that evening after 7pm informing me that Dad had been returned to the hospital, again without notice, with no complaints of his own, stating they were unable to care for him. I was told to come and pick him up at the hospital. Dad is a stroke victim, can not stand and has Alzheimer's disease. He needs special equipment, including a hospital bed for his personal care. I refused to take him home, stating I did not have the appropriate equipment or support. The police were called and I was interviewed for "abuse". The facility filed a police report against me for "stalking". I was home at the time, speaking with both Hospice and my attorney, trying to figure out what to do. Hospice they found a bed for him the following morning. We both spent the night at the hospital emergency room, Dad in a gurney, unable to get up, and me in a chair.
I am Dad's guardian and have seen this happen repeatedly to unaware victims. The nursing home kept the remainder of the monthly fee, in excess of $6,000 and I had to pay for the hospice bed, while I frantically searched for another facility. I have since learned there are many ways for slick predators who have made their way into the Elder industry to take advantage of our elderly and their families. They have numerous unscrupulous ways to kick anyone out if they so desire. When it's all said and done, it's their documentation that proves out, not you or your loved ones needs. Elder Care has become the new crime of the 21st century, and we are the victims.
Medicaid is the answer and each state administers the application process. Here is a website that has links for the states. Click on your state (Don't bother filling in the application form): http://medicaid-online.com/state_list
I am in the process of obtaining Medicaid for my husband. The agency gave me a processing number which the nursing home is now obligated to keep him and I do not have to send payment until Medicaid notifies me how much we are to pay. Since your mom does not have any other funds the process should be quick and dry.
The Alzheimer's organization: http://www.alz.org has a list of your area support groups. They also sent me information on the local government agencies that would help.
All the information people gave you is correct. I am surprised that the nursing home's social worker has not been involved in helping you find other financial resources.
Remember keep asking questions until you get the answers that you need. Don't let them intimidate you. They are there to serve you. You will be surprised what Angel's out there will help you. I received my most support and advice from a social worker for nursing facility that I could not afford and did not take medicaid. She used to be a social worker for the county. She also is the leader for the local Alzheimer's support group.
May God Bless You
My mother is in assisted care and doing well, so well she ran out of money. I contacted American Eldercare, a private agency that supplies the documents for Medicaid. It was no easy process and it took about 5 months. But, when she was finally approved, it went retroactive to the day I first contacted American Eldercare. It is labor intensive, and consumes a lot of time, however, she won't end up losing her home, and she will be able to stay where she is forever, however long or short that may be.
Be thankfull she is still alive. my husband went form being able to drive to end stage chf and is continually halucinating after 48 hours in a nursing home. their night seditive must have done it. they also forgot to change his dressings. bonnie
You've received excellent advice regarding obtaining Medicaid - that is the way to go. Another thing to consider is guardianship. If you have been appointed as your mother's legal guardian by a court, then you have a legal duty to take all the steps to apply for Medicaid on her behalf and get her into a suitable facility. However, if you have not been appointed legal guardian by a court, then you do not have that legal duty. While I hope you still would take those steps on your mother's behalf, if you cannot for whatever reason (your own health, other obligations, etc.), then you may seek to have your state agency for families/welfare take over. If your mother needs a guardian - and it sounds like she does - call your local social services and tell them the situation and what you want. Remember that your local social services is only as compassionate and helpful as the person working there. If they try to tell you that you must bring your mother home or you must spend your own money/take time off work, be confident that this is not true. I know of no state which requires the adult child to be legally responsible for or become guardian of a parent. Good luck.
I believe my dad will need additional financial assistance soon and I also do not have the financial capabilities to help. He currently gets Social Security disability and will be applying for retirement in September. he also has Medi-Cal. Can he still receive Medicaid? I thought there was a limit to the number of government assistance programs one could pull from.
p.s. good luck to the others searching for info and thanks to all of you providing such great advice!
I am not a professional in the field, of elder care, but do have six years of personal experience. Yes, they can and DO put your parent out in the street, don't ever believe that they can't. Dad was returned to his private pay nursing home after a 7 day hospital stay for congestive heart failure. He also has Alzheimer's disease. After he had been released by Hospice of the Valley back to the nursing home, and paying an additional $6Kplus for his next month rent, the administrator, who happened to the be nurse who had originally told me he had level 1 edema, nothing to worry about, which originally led to the congestive heart failure, called the ambulance and had him returned to the hospital, after I had left him after 6 pm on a Friday evening. The hospital would not readmit him, since they had just released him a few hours earlier that day, and on a Friday evening there was no one to call. This administrator had called the police reporting me for "stalking" the facility, all the while I was sitting in my home, unaware of what was happening. I was informed by the hospital that Dad could not stay, and that I would have to take him home. I refused, since I had had him in my home off and on for the previous 4 years, he weighed over 200 pounds and was unable to stand. I had already injured my back from lifting him without any support. The police showed up at the hospital to arrest me! I was blindsided by the unscrupulous nursing home administrator and the events that were taking place. I called in hospice and they found Dad a temporary bed in a hospice facility for 4 days, while I once again searched for a new placement. And, this was private pay! There has been no one to assist with getting Dad on Medicaid and have found the elder care industry to be as corrupt as the mob. I was a self-supporting, affluent, single professional when this began. I have since lost my business, my income, my health, and my home. I was never given a refund of the rent that was required in advance.
In Maryland, where I work , she should stay in the nursing home, and convert her status over to long term care, from rehabilitation. Apply for a long term care Medical assistance card(Medicaid), which takes over payment from Medicare. She would have to be eligible for a 'level of care" for long term care, meaning that she has a medical condition that requires skilled nursing care. I am assuming that at her age and with her injury that she would likely qualify. You do not HAVE to take her home with you, although many facilities will try to make you think that you do. Just DON'T agree to take her home, if you feel that you can no longer care for her in your home. That is certainly Ok. I am a social worker who works with families in this situation all the time. Hope this helps. There is also the Medicaid waiver program, which is a federal program through all 50 states, taht would allow her to come home, with resources such as an aide, etc. in place to allow her to recieve the same level of care in the home as she would in the nursing home. Ask the Staff about applying for this.
The nursing home should assist you to convert her over to MEDICAID, which is different than MEdicare . Medical Assistance for long term care is what she should be eligible for. She may also be eligible for what is known as the "medicaid waiver for older adults" This would allow her to receive the same level of care in the home (in the community) in the least restrictive setting. This allows people that are in nursing home to be discharged , with the appropriate supports and resources in place, and it is paid for by Medicaid, so long as the cost of care in the community remains lower than nursing home care cost. I am assuming that due to her age and her injury, that she would recieve a "level of care". This would allow her to be eliglbe for the MEdicaid waiver. HOpe this helps.
To cfith13: Medi Cal is the same as medicaid
To the Anonymous care-giver: I am so sorry that you are going through this. I am amazed at what is happening with caring for the elderly!!
My mom is 93 today and she has been in rehab for 2 weeks following a short bout of pneumonia. Somehow she fell while in rehab?? and now she has a fractured pelvis. So... she is getting worse in the place that she was sent to recover from a lung infection and et stronger so she could go home?? Go figure? Before her fall last week, we had planned on moving her to a much better rated rehab facility but were told by an estate planning person that if the new facility does not accept medicaid then not to have her go there. I was not impressed to hear that! My mother has medicare and a supplemental insurance, so we want her to be at the best place possible where hopefully she will recover and not get more injuries! I was upset to be told not to send her somewhere better only because of concerns of her having to go onto medicaid sometime in the future. We were told that if any facility gets wind that she is not going to be a "self-pay-bed" in the future, they will ask her to leave!! First, imagine referring to a 93 year old woman with a painful pelvic fracture as a "self-pay-bed". Next, why is her level of care not a priority... but rather how she will be paying in the distant future? We just want her to get the best care possible so she has a chance to recover and go back home to her assisted living apartment... which would be a much better situation for her and medicare/medicaid. With that said, if her recovery is many, many months. We could end up like "Anonymous Caregiver", and have no place for her to go and not enough funds to have a choice. Bad state of affairs for our parents who have worked so hard their whole lives. I mean no disrespect to Barbara Repa.. however, I have spent weeks contacting agencies like you have listed and no one has answers. There is a shortage of facilities, long wait lists, and none of the programs are being funded. So the ombudsman and advocates for the elderly is a great concept that may have been viable in the past but currently there is not much anyone seems to be able to do. Thank you for participating in this forum. Good luck to everyone.
been there, done that, long arduous process with Medicaid but well worth it, I can't even begin to tell you how stressful my poor mother's end of life care was for her and for me and my family once she was no longer able to care for or think for herself, something is very wrong in this country that we treat our elderly like yesterday's garbage after they have worked so hard to get all the things they have sacrificed for through the years just to have it all taken away for health benefits & coverage (at the nursing homes or assited living facitlites) it makes me very, very sad to say the least, on the other hand never give up and never stop trying to help your loved ones at end of life, they derserve it after caring for us thier whole lives :-(
I am finding out how difficult it is to be old in this society. Like JoannePB said, if your loved one has to go into a nursing home and try to get Medicaid to cover it, and you and they have to deal with all that goes along with that, you see how stressful it is and how ugly end of life can be. I am frantic trying to find out where my mother can go if Medicaid does not pay for her nursing home. None of us in the family can take her as she needs a lot of care. And none of us is wealthy enough to afford the nursing home for her. ( almost $10,000 a month!) I would like to know how many Americans can afford that when they get old.
i'm shocked that nobody has mentioned that none of this matters as long as the parent is of sound mind and can say "i want to go home" . In PA they have to sign themselves into the nursing home even if the Dr and children do not agree.
I have few years experience working with seniors, and I meat many families looking for a place for their mother/father, grandparents, aunt/uncles. Families are faced with different situations such as they need to move mom from the fancy facilities because they can't afford them anymore or the facilities can not provide the care your loved one needs. As a Personal Care for Senior owner and a Senior Advisor, I would like to get the information out there that there are more options for seniors out there then most of the families know. You can find more information on www.hopeformomanddad.com and find out the differences between seniors options.
It sounds like you are in quite a tough situation. You do have some options but a lot of it depends on where you are located and what services are available in your community. The first option is to talk to the Case Manager or Social Worker assigned to your Mother. If she already has Medicaid you may be able to get her transferred to a Long-Term Care facility that accepts her Medicaid benefits. They are tough to find and unfortunately the good ones fill up fast but they are also your best option at this time, if she has Medicaid in place. If not another option for you to look into is something called a Rehab hospital, it doesn't bill the same way as a short term rehab/nursing home bills. It will acutally bill her Medicare and treat it as a hospital stay as opposed to a Rehab stay. So the hundred days will not matter in that case. This can usually give you a little time to put a plan in place if the first option doesn't work and it also still gives you the chance to have her transferred to a Long-term Nursing placement setting. In the meantime there are some additional resources your Mother might be eligible for that with some time and legwork could turn out to be very beneficial. I'm assuming by the comment about signing a resident in PA that you live there. Most states have something along the lines of a Waiver program for people that are low income seniors to provide assistance. If a patient qualifies under a certain dollar amount most being under 2000/month or a current Medicaid patient they will qualify. Basically it will cover some costs of a caregiver, in home providers, food, cleaning services etc. Here is the link for Southwestern PA www.phlp.org. If you do not live in the area that I pulled or you live in another state the easist thing to do is to pull up your state's website and start searching low income services and it should most likely pull right up. (I live in TN and have used a service similar to this many times for my patient's and their families it may not fix everything but every little bit helps). If she is a veteran or a widow of a veteran that will also help with financial assistance and may enable you to place her in an assisted living type setting or once again cover a cost for Caregivers. Widows can recieve up to approximately 1500/month and veterans up to 1700/month. The downside to VA benefits is that it is a lengthy process not only to fill out paperwork but to get the services approved. I've seen it take 6 months or longer depending on the person. Like I said though these are options that if you can't have her placed are longer term solutions and assistance that you could look into for her. The last suggestion I have is if you are left no other choice but to bring her home (because if you choose to keep her there most SNF's will start charging you an out of pocket daily rate which is quite pricey) make sure you have some sort of Home Health Services set up for her. Under her Medicare benefit Home Health is covered at 100% and most Home Health companies will have a Social Worker that can come out to your home and assist you with finding all the programs in the area to get your mother placed safely or to make sure if she is staying with you that she is safe. Don't give up hope there are so many resources out there that people that aren't in the healthcare world aren't as knowledgeable about. But hooking up with the right people in your community can only help you with your options going forward. Best of luck to you and your family.
I am so sorry to hear that your are going through a tough situation, I advise you talk to your local social worker, medicare is only good for 100 days, after that you are on your own. Medicaid covers long term care services and I believe that your mom will qualify the poverty criteria. However, you only receive care in medicaid qualified facilities, but if your mom wish to receive long term care services at home, then you may opt for PACE (programs of all inclusive care for the elderly) if you are in the service area of a PACE organization. Visit your state's medicaid website, I think they have an online application, or you may want to visit your local medicaid eligibility office.
Here's a couple of resources to help you out with medicaid application and other government long term care programs: http://www.infolongtermcare.org/ltci-learning-center/what-is-long-term-care-insurance/government-long-term-care/ http://longtermcare.gov/medicare-medicaid-more/medicaid/applying-for-medicaid/
It is shameful how the nursing homes can get away with some of this! They should not be able to kick out a sick elder with Alzheimer's. And since when can a hospital refuse to take someone?! We should all be up in arms and contacting our lawmakers. This should not be allowed to happen. I came close to a nervous breakdown wondering how my mom, who went in a hospital after a 4th or 5th fall, and then in rehab, was going to be able to financially stay in a nursing home. She has Alzheimer's and I live in another state and could not take care of her anyway. It is abhorrent what the states and facilities try to put on family members. I love my mom and wish I could take care of her but even if I gave up my life as it is to do it, I couldn't. She needs more help than I could give her. We must all stand up and do something because the problem will only get worse. Good luck to all in this position. There are many good responses and advise here.
If the 100 days covered by medicare is over, you or your mother will be responsible for the full cost of the stay, the options you have is to check if your mom have medigap or medicare supplemental policy, if she has long-term care insurance or apply for medicaid. However, medicaid application do not assure that your mom will be eligible immediately, it is a process. You can check with your local department of aging to see if you state has other programs that can help your mother, you did not inform us where you are located. Each state has they own long-term care programs, or you can check with SHIP (http://www.shiptacenter.org/). You may also check with http://www.longtermcareprimer.com/state/ and click on the state where you are located, it would show resources regarding your states long-term care services and programs.
My grandmother is 81 years old after numerous falls and constant drinking. My grandma ended up in the hospital which led to rehabilitation for alcohol withdrawal. Myself and family member signed her in for long term care. She was diagnosed with dementia and hypertension. Her out burst about wanting to go home and aggressive behavior has caused the nursing home to prepare for discharge. With no one willing to care for her. Yet again she will return to home, in which I reside with my 2 children to tolerate her verbal abuse. We are tired of it!! The nursing home states if a patient do not want to stay here it's against to the law to keep them where they don't want to be. If round the clock staff can not handle her, I don't know why they think myself and 2 kids can, in which they are 11 and 7yr old girls. It's been peaceful for 4months. We stopped visiting her due to the swearing and the hostile behavior she displays towards us. Please help, I'm depressed and full of fear that my grandma will return and make our live miserable!!! Miserable in NYC!!
I couldn't have said it better!!! It's amazing to me how this country so rich in its resources, which by the way was our elderly who worked day and night sometimes to get us there. We can bring refugees from other countries that may or maynot be a threat to our way of life, but can't help our elderly the very ones who made it possible in the first place; the help they deserve in their time of need, their end stage of life. This country is the best country to be privileged to live in, but the way our elderly and the families that try to care for them, are being treated, is unexceptionable. It's time for us to write our senators and start a petition to make a change.
My father has medcal (medicaid) and medicare. He was recently placed on hospice. I asked his hospice team if they could help place my dad in a nursing home as he can no longer care for himself. They are currently looking. The hospice doctor said my dad qualifies because he has Medi-Medi. It has been two weeks and they still haven't placed my dad. I'm sure these things take time and hospice is busy. It is hard on my dad to be alone. I live too far away to help daily. I see him once a week only.
I can volunteer my time to help care for you mother. I was a caregiver to my father until he took his last breath. I refused to put him in a nursing home because I knew it was not what he wanted and for me too. After he passed I worked for a home hospice company in PA.
I do not expect payment of any kind. I volunteer my services because it brings me peace in knowing that I could help another family be with their loved one, making memories with the little bit of time left.
I do know how to get medicare and Medicaid work and I can help navigate through the red tape.
I do no know where you live, I live in CO.
I know that this is very hard on you and your loved one. You will decided what is best for you and loved one. If I can help in anyway, please do not hesitate to email me.
Please advise your clients that getting into a skilled nursing facility (SNF) under MediCal or Medicaid is getting more difficult. I'm the Admission's Director at a SNF and I have a VERY long waiting list for MediCal clients. All four facilities in my area are the same. I get calls EVERY DAY from all over Northern California and Nevada looking for placement, so if you decide to "creatively" disburse assets, good luck finding a place that will take your loved one, especially if they are younger than 90.
I just spent an entire hour typing a post and it erased it while I created my account. I will re-type it when I have any brain function left while caring-for-my-mother. P.S. I have no options and Medicare does not pay for AL in PA. Mom wouldn't qualify anyway since her income exceeds by $190/month (she is not eligible for Medically Needy, either because her income exceeds the $2400/month by $1.00). They will not let her go home because she is not safe there and she cannot afford her mortgage so she is losing the house. No assets. No help. Losing my mind, friends, family and now 2 full-time jobs down the drain from being the one sibling "taking one for the team" here in NE PA. Sending love and light to all of you suffering along with me.
Program of All-Inclusive Care for the Elderly. The Programs of All-Inclusive Care for the Elderly (PACE) provides comprehensive medical and social services to certain frail, community-dwelling elderly individuals, most of whom are dually eligible for Medicare and Medicaid benefits .
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