Doctor says my mom should be in an assisted living facility but we can't afford it

[ralphboy]

My mom is poor. She gets $1200 a month in social security and retirement. She has Medicare and Humana Gold for her insurance and resides in Florida. She currently lives in a low income apartment by herself (Her rent is a percentage of her social security). She is legally blind (Has diabetic retinopathy) and has fallen twice this month. The first time she was on the ground I believe for several days when I found her and was in the hospital for 2 weeks and a nursing center for 2 weeks (She had pneumonia and a blood infection). She fell again when she returned home and when she visited her doctor for an evaluation her blood pressure was 200/100 (She forgot to take her meds the few days she returned home). Due to my mom falling, having trouble doing things around the apartment due to her blindness, and her forgetting to take her meds; her doctor says she should be in assisted living. The issue is we can't afford it.

I try my best to help her out as much as I can but it is difficult taking care of her and having a full-time job. I am setting up her pill box each week and I have ordered her a mobile alert device which can detect falls and has a button for her to press if she needs help. I am also trying to make it a habit of calling her each day. I wish there was more that I could do to help make her life easier. Are there any options available to me? I think she can apply for Medicaid but I can't figure out how to sign up for it (Tried googling it but became overwhelmed by the information/ junk sites; why can't they make medicare simple for seniors to understand?)

[White Coat Investor]

I'm not sure Medicaid pays for assisted living, but it does pay for skilled nursing facilities. Not sure she's bad enough to need it yet.

I'm sorry you're having to deal with this. It's very common. It takes a lot of money to retire with dignity.

[wolingfeng]

Definitely try to get her Medicaid, not sure FL, but in NY you go to Local Department of Social Service. For people with Medicare, so she will have her Medicare as her primary and Medicaid as her secondary insurance. In NYS for certain people that are eligible, their Medicaid also covers Long Term Care (LTC), which offers certain hours of home health aids based on certain eligibility criteria. Medicaid will provide extra help, but unfortunately you will still be the one navigating everything (which is a lot of work), making sure she signs up for it every year, and coordinate her care, including LTC if she's eligible. So in a way it's not a silver bullet, but definitely provide the extra help. Best luck.

[SpaghettiLegs]

That is a tough situation and unfortunately, all too common in the US. Check to see if there is a PACE (Program for All-inclusive Care for the Elderly) program in your Mom’s area. They are accountable care organizations set up with some government funding, often run or supported by a local hospital system. They will include primary care, social and day services, transport to appointments etc. They will often do home visits.

[ResearchMed]

Does your mother's physician's office have a social worker or similar?
Or the hospital or nursing center?
They should be able to help at least with some of the paperwork, and then also with the process of finding a medically safe place for her.

Is there a local (in her town, especially?) Office/Agency for Elder Affairs?
There may be some local agency who can also assist with finding services or may even provide some services.

And if the contacts you do find can't help, ask them for referrals. Your mother won't be the first person who needs some help with these types of services.

If her income is only $1,200/month, I would have thought she'd already be eligible for Medicaid, but that may vary by state.

RM

[Caduceus]

She fell and went unnoticed for several days? Not sure if I was reading the original post right.

What we did with one of my grandmothers as she got older was we set up a camera in common areas that close family could then monitor via an app on our Iphones. We were concerned precisely about this sort of thing - that something would happen with her and no one would know in time to help. That's one option if she's OK with the loss of privacy in specific areas of the home. Calling her once every day at least is also a good idea. My parents did that for my grandparents.

Wondering if it would be possible for you to pay someone in her apartment building to help your mom out whenever she needs it. Maybe a housewife who's usually at home. Wouldn't be a lot of money if she's amenable to it and your Mom gets help with whatever she can't do around the apartment.

Or, is it possible for her to move in with someone in the family?

[ralphboy]

Check to see if there is a PACE (Program for All-inclusive Care for the Elderly) program in your Mom’s area.

Pace is in her area

Does your mother's physician's office have a social worker or similar?

The office has a case manager. She said she would look into assisted living facilities but only sent me a link to one and then mentioned that the average cost for assisted living facilities is $3500 in Florida.

She fell and went unnoticed for several days? Not sure if I was reading the original post right.

Yes she fell by the side of her bed and could not get help. She thinks she was there for several days. She had a doctor's appointment in the morning and when I went over to her place, I found her on the floor.

Or, is it possible for her to move in with someone in the family?

I have a brother with a home and a guest room but I doubt he would want to take my mom in. He wants to have fun and be with his friends. Since he lives farther away from her, I'm the one who is taking care of my mom but I live in a small 1 bedroom place.

If her income is only $1,200/month, I would have thought she'd already be eligible for Medicaid, but that may vary by state.

My mom and I didn't even know about medicaid. I just thought seniors got medicare and a supplemental insurance.

[pizzy]

Check to see if there is a PACE (Program for All-inclusive Care for the Elderly) program in your Mom’s area.

Pace is in her area

Does your mother's physician's office have a social worker or similar?

The office has a case manager. She said she would look into assisted living facilities but only sent me a link to one and then mentioned that the average cost for assisted living facilities is $3500 in Florida.

She fell and went unnoticed for several days? Not sure if I was reading the original post right.

Yes she fell by the side of her bed and could not get help. She thinks she was there for several days. She had a doctor's appointment in the morning and when I went over to her place, I found her on the floor.

Or, is it possible for her to move in with someone in the family?

I have a brother with a home and a guest room but I doubt he would want to take my mom in. He wants to have fun and be with his friends. Since he lives farther away from her, I'm the one who is taking care of my mom but I live in a small 1 bedroom place.

Can you and your mother pool resources and get a 2 bedroom apartment?

[ralphboy]

Can you and your mother pool resources and get a 2 bedroom apartment?

I might have to but I was hoping for another option. I don't really want to live with my mom (I'm in my 30's and want to have a life). I've been spending a lot of time with her over the past 3 years (When she got diabetic retinopathy) and I get depressed having to spend 5-8 hours a day with her on my days off of work or having days where I'm with her a lot and then I have to go to work. I miss having some "me" time.

[Silentnight]

https://www.flmedicaidmanagedcare.com/h ... ealthplans
In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. People on Medicaid will get services using one or more of these plan types:

• Managed Medical Assistance (MMA): Provides Medicaid covered medical services like doctor visits, hospital care, prescribed drugs, mental health care, and transportation to these services. Most people on Medicaid will receive their care from a plan that covers MMA services.

• Long-Term Care (LTC): Provides Medicaid LTC services like care in a nursing facility, assisted living, or at home. To get LTC you must be at least 18 years old and meet nursing home level of care (or meet hospital level of care if you have Cystic Fibrosis).

For which health plan services are you eligible?
Please enter your zip code or select your county of residence:


https://www.medicaidplanningassistance. ... y-florida/
Medicaid is a health care program for low-income individuals of any age. While there are various coverage groups, this page is focused on long-term care Medicaid eligibility for Florida senior residents (aged 65 and over). In addition to care services in nursing homes, adult family care homes (adult foster care homes), and assisted living facilities, FL Medicaid pays for non-medical services and supports to help frail seniors remain living in their homes. There are three categories of Medicaid long-term care programs for which FL seniors may be eligible.

1) Institutional / Nursing Home Medicaid – This is an entitlement program; anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.

2) Medicaid Waiver / Home and Community Based Services (HCBS) – These services are not an entitlement; the number of persons who can receive these services is limited and waiting lists for some services may exist. Intended to delay nursing home admissions, long-term care benefits are provided at home, adult day care, in adult foster care homes, and in assisted living residences via a managed care system. (snip)

.....The three categories of Medicaid long-term care programs have varying financial and medical eligibility criteria. Financial requirements change annually, vary based on marital status, and is further complicated by the fact that Florida offers alternative pathways toward eligibility.

...The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long-term care from a Florida Medicaid program. Alternatively, one may take the Medicaid Eligibility Test. IMPORTANT: Not meeting all the criteria does not mean one is ineligible or cannot become eligible for Medicaid in Florida. More.

https://www.medicaidplanningassistance. ... -smmc-ltc/
Florida’s Statewide Medicaid Managed Care (SMMC) Long-Term Care (LTC) Waiver Program provides a variety of long-term care services and supports for Florida residents who are elderly or disabled and require a Nursing Home Level of Care. While nursing home care is a benefit available via this program, a variety of home and community-based services (HCBS) are also available to program beneficiaries in their home, the home of a loved one, an adult family care home, or an assisted living residence to prevent and delay the need for institutionalization (nursing home admission).......


These 3 sites should help you get started on your research.

[stan1]

I am not familiar with FL, but UT for example has a program that lets Medicaid patients who can live in assisted living do so (because it costs less than having them in a full nursing home). In Utah this is called the New Choices Waiver Program, but Medicaid is state program and there are very wide variations in terminology and coverage. It is capacity limited and has a waiting list.

Another point is that there no longer is a clear separation between assisted living and nursing home care. Nursing home licensing is also state by state, but care is now often "a la carte" with different levels of care based on a patients requirements for assistance.

I'd consider hiring an attorney office who specializes in Medicaid claims including documentation for look back reviews. This is very common in some states and is a different specialty than elder law. Again not sure about FL though for your mom's situation. The processes are bureaucratic so it helps to have someone who knows the rules and how to fill out the forms. It can save you a lot of time.

[TJSI]

Definitely-get-Medicaid-and-you-should-be-able-to-get-a-home-health-aid-worker-to-visit-everyday.--Medicaid-should-pay-for-this-but-you-will-need-the-proper-paperwork.

[ResearchMed]

If the office person couldn't help more than that, please double check for assistance with recommendations for services at the hospital and nursing center where she has already stayed, as they will be familiar with her situation.
Given your description of her situation, I'm a bit surprised they didn't offer followup recommendations or planning before she actually went home.

But that was then; you should ask for that help for her now, and see what recommendations they may have.
This should include local social service agencies who may provdie some home health checks, etc.

RM

[biscuits]

Sorry you are in this tough situation. I think you are right to resist becoming a full-time caregiver for your mom and to look for support from Medicaid and other agencies. You've gotten a lot of good advice and resources here about that.

One more thing: look into services such as Meals on Wheels that will deliver meals to your mom. That's one more person stopping by and making regular contact with her.

[5outof10]

OP, if your mom is legally blind then you may want to call the Social Services office for the county of her current residence and inquire about your mom applying for Florida's Medicaid program.

If her assets are low enough (below $3,000 I think) and she is either blind, disabled, or over 65 then she should qualify.

You may want to try to get her qualified for SSDI but it may be moot because if she qualifies for Medicaid and her income is not enough for her monthly care then they will apply all of her income to her care except for a small amount for toiletries, etc. Meaning she wouldn't be able to keep her SSDI anyway because it would go to pay for her care. She can keep a small dollar amount, I read $180/month somewhere, for personal expenses such as toiletries and clothing.

I just read that Medicaid will pay for assisted living or in home care too, not just nursing home.

But if she is truly blind she may qualify.

I am not an Florida attorney.

[celia]

You should also call the city or county senior center closest to her and make an appointment with someone who knows how to get various services for disabled seniors. Start with getting new housing under supervision of a caretaker (assisted living). Since there will likely be a waiting list, then ask how to get Meal on Wheels to deliver food (5 days a week?), get transportation to medical appointments, how someone can look in on her once a day (by phone?) to see how she’s doing, sign up for Medicaid and see what it covers in her area.

Also the Post Office may still have a program where they will contact someone of her choice (you) if her mail isn’t removed from her outdoor mailbox within a day.

[tonyclifton]

Florida has an “Area Office of Aging” system. Google it and find the office closest to your mom. They are non-profit agencies that assist with the type of issues you are describing. There is a very comprehensive form of Medicaid called “Aged, Blind, and Disabled” which is more like an enhanced Medicare plan. The Area Office on Aging has social workers and case managers who will help you navigate the public/community resources in your area to help your mom. They may be able to arrange for a personal care attendant. Be sure to mention that she is blind during the intake.

[CapeLinda]

There are really good suggestions in previous posts.

I would agree with Celia - re the local Council on Aging in terms of services locally. There are also services for vision impairment to maximize her independence and safety including adapted phones, medical alarm buttons as examples. Services through Council on aging are subsidized as well - so negligible costs and they would be aware of access to other services in your area, contact persons.

You don't mention that she had a home care agency follow her at home. What were the discharge instructions from the nursing home? Be aware that post acute care - individuals are not at their maximum functioning level! Unfortunately - that's often when decisions/recommendations are made. Referrals to home care agencies used to be standard post nursing home discharge. Here is the medicare website - to assist in choosing an agency. I would ask if they have staff ie Occupational Therapist who specialize in low vision.

https://www.medicare.gov/care-compare

Best of luck - not an easy journey, although there is a lot of help available. Unfortunately, it tends to be fragmented, disjointed.

[OpenMinded1]

She fell and went unnoticed for several days? Not sure if I was reading the original post right.

What we did with one of my grandmothers as she got older was we set up a camera in common areas that close family could then monitor via an app on our Iphones. We were concerned precisely about this sort of thing - that something would happen with her and no one would know in time to help. That's one option if she's OK with the loss of privacy in specific areas of the home. Calling her once every day at least is also a good idea. My parents did that for my grandparents.

Wondering if it would be possible for you to pay someone in her apartment building to help your mom out whenever she needs it. Maybe a housewife who's usually at home. Wouldn't be a lot of money if she's amenable to it and your Mom gets help with whatever she can't do around the apartment.

Or, is it possible for her to move in with someone in the family?

During the last few years of my grandmother's life, she was rotated from one of her children's residences to another on a regular schedule each year.

[valleyrock]

This is a national problem.

One solution involves teaming people who need live-in assistance with people in need of a job. In exchange for room and board, plus a fee, a person moves in and takes care of the person's needs. All of them.

I arranged just such an approach for my mother. Two people rotated, one week on and one week off, taking care of all her needs. It was less than perfect, but the perfect on these matters is often the enemy of the adequate, and it's flat out unaffordable, anyway.

There are many associated issues here, which could be the subject of a thread on LTC.

[vested1]

I would also visit some of the local assisted living facilities in order to check the suitability, cleanliness, and staffing level. We did this for my MIL and found one that was moderately priced that accepted Medicaid. It was the only one that fit the bill out of at least a dozen we visited.

There are other programs for the blind that you could take advantage of as well. The library of Congress will supply an audio book player and a vast number of audio books to choose from at no cost. We did this for my MIL, who was also blind and immobile. The audio books got her engaged and improved her outlook tremendously. The player comes with a headphone jack, so if she's in a shared room she can use earphones to listen to the audio book without disturbing the other resident in her room.

There are also wire line phones that are "blind friendly", with large buttons and raised numbers. Most elder facilities will provide a wireline connection for each resident. Placing a small piece of velcro on the zero will help orient the blind person to the number they want to dial. We also supplied a cell phone for my MIL with Alexa capability and entered all of her family and friends in her contacts so that she could simply ask Alexa to dial the person she wanted to talk to.

My MIL's facility also allowed us to buy extras that would help her, so we got her a Keurig coffee machine that was easily operated by touch, and her favorite pods were placed within easy reach. The staff were helpful in keeping the Keurig filled with water. She was in that facility on Medicaid after her savings ran out for another 4 years and died at age 94. It wasn't assisted living however, but more of a skilled nursing facility in California at $8,500 a month, which was a bargain compared to other options.

[ralphboy]

Does my mom keep medicare if she is able to sign up for medicaid? Should she get rid of her humana gold plan? Yes, if I can speak to someone about my issue that would be best. If they could help me fill out the form... that would be better. Trying to navigate all of this is very difficult. Meals on wheels is a great idea. If I could get someone to help her with doctors appointments that would be nice (Even though my mom wants me to take her). I would be less stressed if I had a team of people helping me. I'm in St. Petersburg, FL if that makes a difference.

[Shackleton]

First off, you’re doing a good job trying to figure this out. It is overwhelming. I’m not 100% certain since it varies by state, but my understanding is that Medicaid would replace Medicare and her Humana Gold plan. But I really suggest you read the links posted by Silentnight above (viewtopic.php?p=7272473#p7272473)

Also, the “case worker” at the doctor office is probably not a trained “social worker” which is what you need. The case worker may just be the billing person assigned to your moms account at the doctors office. Again, start by rereading and looking at the three links posted by Silentnight above.

[Shackleton]

Also, your brother needs to understand how much effort and time you are putting into this. It’s not fair for it all to go to you just because you live closest. He can help by reading up on Medicaid and other programs and communicating with you about the various options. Unless he’s like my brother, who would have been absolutely no help and more of a hindrance… I ended up handling everything for our mom, but my brother was at least very grateful and thanked me often.

[Damocles]

My mother was in a similar situation for about 3 years. We set her up with a Phillips Life alert, installed a combo key box on the outside of her home, and provided Phillips and local Police and EMS the key combo. This was immensely helpful for responding to her relatively frequent but not otherwise serious falls.

Also, the policy of our local EMS was to not charge for a "Lift and Assist" visit. If my mother needed hospital transport, it would be $300-500. But if she fell and just needed help to get back to her chair or bed until a home health visit could be arranged in the morning, she'd ask the Firefighters/Paramedics for "lift and assist" (and sign refusal for transport) and there would be no charge.

This might be something to ask your local EMS about, along with the other great suggestions in this thread.

[John Doe 123]

Can you and your mother pool resources and get a 2 bedroom apartment?

I might have to but I was hoping for another option. I don't really want to live with my mom (I'm in my 30's and want to have a life). I've been spending a lot of time with her over the past 3 years (When she got diabetic retinopathy) and I get depressed having to spend 5-8 hours a day with her on my days off of work or having days where I'm with her a lot and then I have to go to work. I miss having some "me" time.

I don't have any advice for you, but I wanted to let you know that this post "hit me in the feels." You are a good son.

[InMyDreams]

So...they discharged your mother from the Skilled Nursing Facility (SNF) and then the doctor told you that your mother needed to be in an Assisted Living Facility? Hmm. I don't know the regulations, it's true - but I'm surprised that the SNF wasn't on the hook for discharging your mother to a safe situation.

Did they discharge her with Homecare? Why not? Seems like she should have had Skilled Nursing into the home for at least a short while to make sure of things like medication management, home safety, etc. That would also have brought in a home health aide a few times a week to assist with baths, etc.

Others have mentioned Social Work (yes!), but another resource you might tap into is Senior Medicare Patrol. They can assist if your mother has been denied Medicare benefits that you feel she should have been entitled to.

Unfortunately, when we most need help, we are least able to pull the levers to make it happen. Thank you for helping your mother and keeping an eye out for her best interests.

[ResearchMed]

So...they discharged your mother from the Skilled Nursing Facility (SNF) and then the doctor told you that your mother needed to be in an Assisted Living Facility? Hmm. I don't know the regulations, it's true - but I'm surprised that the SNF wasn't on the hook for discharging your mother to a safe situation.

Did they discharge her with Homecare? Why not? Seems like she should have had Skilled Nursing into the home for at least a short while to make sure of things like medication management, home safety, etc. That would also have brought in a home health aide a few times a week to assist with baths, etc.

Others have mentioned Social Work (yes!), but another resource you might tap into is Senior Medicare Patrol. They can assist if your mother has been denied Medicare benefits that you feel she should have been entitled to.

Unfortunately, when we most need help, we are least able to pull the levers to make it happen. Thank you for helping your mother and keeping an eye out for her best interests.

This ^^

I really suggest that you contact the previous two facilities she was at.
I agree that it doesn't make sense that they would just "discharge" someone in this condition and "send 'em home" without followup instructions and recommendations for services.

You really should get a professional to help, of the types recommended above (including from the facilities) but also local social services/elder care agencies.
The nursing facility really should have contact information.

You are terrific for helping, but there are services available, so get someone local knowledgeable to help you, rather than relying upon us here, in assorted geographical regions (where the set up of services may be quite different). This will make it easier/faster for you, and also help your mother.

For starters, try a search for "elder care".
What came up for me just now was, first, a couple of ads for paid services, and then the contact information for the government agencies in our town and several nearby towns.

RM

[quantAndHold]

Indeed, if she fell again as soon as she got home, it sounds like the nursing center didn’t do an evaluation to see if she was safe at home. I was in the hospital for a single night and multiple people came and did discharge evals. I would call the nursing home, explain that they discharged her into an unsafe environment, and ask for social worker help getting her settled somewhere safe. I would also file a complaint with the state about them releasing her like that, but I’d see if they could help first.

If she qualifies for Medicaid, she gets both Medicare and Medicaid, and you won’t need the supplement l which should save some money.

[ralphboy]

Basically I received a phone call from my mom's doctor to make an appointment for her to be evaluated and to see what type of physical therapy she needs. I think my mom was "kicked out" of the nursing center because her insurance only covered the visit for a certain amount of time. My mom said something about being discharged and Humana but I don't know. Anyways, she got out on Saturday and had an appointment to see her doctor on Monday. Saturday evening she fell (Was using her walker to get to the refrigerator and thought she "saw" something roll from the bottom of the fridge and went to grab it and fell. Sunday morning she called me and told me she fell and I told her to call 911. She is really close to the fire department and they came and got her up before I could visit her (This was on mother's day).

My mom's doctor has her doing physical therapy next week (It is at the doctor's office location). She said my mom needs to be in an assisted living facility. I spoke to the case manager and told her my mom only makes $1200 a month. She e-mailed me, an assisted living facility but I don't see a price for it (https://www.freedomsquare-seniorliving. ... -block-208) and then she said, "The average cost of assisted living facilities in Pinellas County is $3123 per month." I then told her again, my mom only makes $1200 a month and she said, "Since she pays a lower amount of rent, see if she wants to just stay where she is. If you need anything further please let me know."

So I'm back at square one. It looks like my mom does not qualify for Medicaid because she has about $8,000 in checking and savings.

[pizzy]

She e-mailed me, an assisted living facility but I don't see a price for it (https://www.freedomsquare-seniorliving. ... -block-208) and then she said,

What did Freedom Square say when you called?

[ResearchMed]

What did the elder services agency say when you called them?
(There may be more than one.)

RM

[ralphboy]

I haven't called freedom square but I will ask about price. I haven't called any agency yet but the services coordinator where my mom lives knows about PACE and another service called CARES. I'll talk to her and then call PACE and see what things they can do to help us out.

[delamer]

Can you and your mother pool resources and get a 2 bedroom apartment?

I might have to but I was hoping for another option. I don't really want to live with my mom (I'm in my 30's and want to have a life). I've been spending a lot of time with her over the past 3 years (When she got diabetic retinopathy) and I get depressed having to spend 5-8 hours a day with her on my days off of work or having days where I'm with her a lot and then I have to go to work. I miss having some "me" time.

To be fair to you and your brother, neither of you is in a position to provide the 24/7 surveillance and help that your mother needs.

You have to support yourselves, which means going to work.

I haven’t read all the replies in detail, but have you contacted her county’s office for the aging to see if they have any suggestions?

[ResearchMed]

I haven't called freedom square but I will ask about price. I haven't called any agency yet but the services coordinator where my mom lives knows about PACE and another service called CARES. I'll talk to her and then call PACE and see what things they can do to help us out.

The local elder/social services agencies will be familiar with all/most of these.
Why aren't you calling them?

RM

[ralphboy]

The freedom square had a chat robot and it said assisted living starting from $2025 a month. I then selected "out of budget" and went through the following prompts:

Click all options that apply to the situation.

Own a Home
Retirement Savings
Savings/Investments [x]
Life Insurance Policy
None of the Above

Are any of these options available to pay for senior living?

Proceeds from Home Sale
Savings/Investments [x]
Retirement Savings
Long-Term Care Insurance
Veterans Benefits
Medicaid
Not Sure

Then I got a message saying that someone would call me. So I'll talk to a person and explain the situation but right now I have to get ready to go to work.

[ralphboy]

I'll call the local Council on Aging. I'm trying right now to get a gameplan and figure everything out.

[arcticpineapplecorp.]

look into the waiver/HCBS program (through medicaid, that's the State benefit, not medicare which is federal) Silentnight mentioned. Sounds like she might be financially eligible for that program based on the limited information you've provided, but whether she's medically eligible is the question. Let them assess her medically and if eligible, she'll get the in home health care she needs.

[HomeStretch]

Your mom’s assets of $8k can be spent down quickly (in days) in a Medicaid-compliant way, if necessary, to qualify for Medicaid. Medicaid varies by state. For my dad (not in FL), his assets could not exceed $2k. I spent down his assets in a couple ways including the attorney fee for the Medicaid application assistance ($10k) and I prepaid his funeral costs in a Medicaid-compliant burial Trust ($14k) handled by the funeral home.

All great suggestions, above. My two cents is that you should make all the calls to the Aging/Senior groups mentioned above for advice. Just be aware that there is a lot of demand for public assistance and the waits for assistance /admissions/Medicaid approval are long (months). Elder law attorneys are busy, state Medicaid depts are understaffed for reviewing Medicaid applications, facilities have long admission waits especially for day-1 Medicaid patients.

Your fastest route may be to call and visit various facilities yourself to see if they have an immediate opening, if they accept Medicaid assignment and if they will admit your mom while they file for Medicaid on her behalf. You can offer to private pay for a couple months between your mom’s $8k assets, her SS income and you/your brother contributing, if necessary, in order to jump the admissions waiting list.

An alternate route, if she is hospitalized again, is to refuse her discharge after her next hospital admission by telling the hospital social worker that she is not safe at home. In my state, the hospital can’t kick the patient out, they will have to find a facility willing to take her upon discharge for rehab. Medicare will pay for rehab for a period of time only. Use that time to find her permanent placement.

Use your time starting NOW to find her a facility and apply for Medicaid benefits. Pay an elder law attorney if necessary for a consultation and to handle the filing.

In the interim, your mom is not safe living alone now. I understand you and brother want a life too. Perhaps you and your brother can stay there on an air mattress a few days a week until you figure this out. Perhaps you can get an aide part time to come in too.

Best of luck. Quality, caring elder assistance is tough to put in place quickly even with adequate funds.

[quantAndHold]

Definitely call the facility she was kicked out of, explain the situation (you kicked her out, she fell again within 24 hours, and her doc says she needs assisted living), and demand help getting her placed. Also, *definitely* report them to the state. They need to understand that they should not be doing that.

As far as the $8k, a couple of months in assisted living would spend that down to Medicaid levels. When you actually get a case manager or social worker or something, they can probably work with that.

[tonyclifton]

I'll call the local Council on Aging. I'm trying right now to get a gameplan and figure everything out.

This is what they do every day they will know all the ins and out for someone in the situation you described. They are also probably the group that runs meals on wheels and enrolls people in Medicaid waiver programs that pay for home health care and personal care attendants. This is the type of agency who does it in Ohio.

[InMyDreams]

Indeed, if she fell again as soon as she got home, it sounds like the nursing center didn’t do an evaluation to see if she was safe at home. I was in the hospital for a single night and multiple people came and did discharge evals.

Basically I received a phone call from my mom's doctor to make an appointment for her to be evaluated and to see what type of physical therapy she needs. I think my mom was "kicked out" of the nursing center because her insurance only covered the visit for a certain amount of time. My mom said something about being discharged and Humana but I don't know. Anyways, she got out on Saturday and had an appointment to see her doctor on Monday. Saturday evening she fell (Was using her walker to get to the refrigerator and thought she "saw" something roll from the bottom of the fridge and went to grab it and fell. Sunday morning she called me and told me she fell and I told her to call 911. She is really close to the fire department and they came and got her up before I could visit her (This was on mother's day).

My mom's doctor has her doing physical therapy next week (It is at the doctor's office location). She said my mom needs to be in an assisted living facility. I spoke to the case manager and told her my mom only makes $1200 a month. She e-mailed me, an assisted living facility but I don't see a price for it (https://www.freedomsquare-seniorliving. ... -block-208) and then she said, "The average cost of assisted living facilities in Pinellas County is $3123 per month." I then told her again, my mom only makes $1200 a month and she said, "Since she pays a lower amount of rent, see if she wants to just stay where she is. If you need anything further please let me know."

So I'm back at square one. It looks like my mom does not qualify for Medicaid because she has about $8,000 in checking and savings.

Hmmm. Medicare pays for home healthcare (including PT and Skilled Nursing, as well as Social Work) for those who are considered homebound. Considering that your mother fell within 24 hours of returning home, perhaps she might qualify?

It sounds like your mother is in a MedAdvantage plan. Even so, the MA plan must provide the same level of benefit that is provided with Original Medicare (tho they may have a daily room charge in the SNF).

Senior Medicare Patrol could help clarify the benefit that she is eligible for, and assist with starting the appeal process. You have a limited period of time to appeal decisions such as a discharge (I'm not sure she is still eligible). You could discuss the discharge decision, the safety of your mother at home, and whether she should be eligible for Home Healthcare instead of outpatient PT.
https://www.smpresource.org/Content/What-SMPs-Do.aspx

[InMyDreams]

MedAdvantage appeal process (go to "Expedited Review")
https://www.hhs.gov/about/agencies/omha ... index.html

Original Medicare SNF benefits (remember, MA plan benefits cannot be less, but they can charge a daily fee up to the MOOP)
https://www.medicare.gov/coverage/skill ... y-snf-care

Home care benefit
https://www.medicare.gov/what-medicare- ... ealth-care

[TheGiantess]

You've gotten great advice already but I just want to add that I am,so sorry you are going through this. It is so hard. My mom is 90 and has fallen twice but she has had enough resources to take care of herself and she can manage living alone. One thing I will say is that you have to be persistent when you call and ask for info or assistance. Always be nice, of course, but keep calling and keep on them. People are busy and the squeaky wheel ..... also, tell them how much you need their help and even if you have to exaggerate your mom's needs a bit, do it. And thank people profusely for their help when they help you. I had to be a little pushy to get my mom the care she needed. Always with great respect and humility but keep calling the person who can help. Persistent and gratefulness pays off. I'm a social worker but no longer in the direct services field. You have to be persistent as best you can given that you work and want to have a life. Make sure you take care of yourself too. This kind of caretaking is so hard. TG

[freakyfriday]

Many have given you great advice one thing I didn't spot.

If she is able to make the decision and willing the a camera in a communal area or otherwise strategic location.

It's not to spy on her but check in easily, the motion alrights can also be useful, it's also useful if you do have carers (whenever or not the presence of cameras should be sign posted you'll have to consider).

Fall alarms as you mention are terrifically helpful.

[HanSolo]

Does my mom keep medicare if she is able to sign up for medicaid?

I'm not an expert on the alphabet soup, but I think what you should look up is "dual eligible" and "QMB" (Qualified Medicare Beneficiary).

I would agree with Celia - re the local Council on Aging in terms of services locally.

Definitely. And I would assume/hope they're able to answer such questions. But they may need your mom to call (I had the experience where they didn't talk to me because I wasn't the person who'd be receiving the services).

[Northern Flicker]

I'm not sure Medicaid pays for assisted living, but it does pay for skilled nursing facilities. Not sure she's bad enough to need it yet.

I think that varies by state.

[sbaywriter]

Medicaid definitely varies by state. User "silentnight" above gives you best references for Florida Medicaid. It really is challenging for anyone to understand so I feel for you. I live in Florida and have researched some of this for a friend and it took me a long time to get it even partly sorted out. It sounds like you are making good progress and have gotten lots of good tips - just be sure to ignore any that don't apply to Florida! Here's some things I found helpful to understand:

Important distinction on two different types of Medicaid:
1. Nursing home (institutionalized) Medicaid - applies to nursing homes only, not to assisted living facilities. Covers all costs once you qualify.
versus
2. Medicaid Waiver / Home and Community Based Services (HCBS) - does not cover all costs but provides some assistance - typically between 1200 - 1500 mo. Can be used for assisted living facilities but not sure if any would be inexpensive enough for her even with this help - but also can use for hiring in home care. There is a long waiting list and your placement on the list depends on how proving how bad off you are health wise.

It sounds like what you need to be looking at is #2 - get on that Medicaid Waiver list as soon as possible, and see if you can get some tips on how to apply so that she can be high on the waiting list.

And in the meantime, check into all those monitoring things like "fall detection devices," cameras, I think there are medication systems that alert if she doesn't take the medication, etc. She will have to spend down assets to 2k to be eligible for Medicaid (of either type), so some of that money can be used toward these things being done to keep her safe.

Also the PACE program mentioned in comments above may be helpful - here's the one in your area:
https://www.suncoastpace.org

This lawyer is based in Seminole and specializes in this kind of stuff but will charge for it of course - he has a lot of good info on his website that I discovered by googling, but it's hard to find it on the website itself. His website says $200 for initial consultation.
https://www.dhclaw.com/

[Beensabu]

I'll call the local Council on Aging. I'm trying right now to get a gameplan and figure everything out.

https://elderaffairs.org/resource-direc ... ers-adrcs/

Call the Elder Helpline at 1-800-96-ELDER (1-800-963-5337)

Or contact your local ADRC:

Area Agency on Aging of Pasco-Pinellas, Inc.

9549 Koger Blvd. Ste. 100
St. Petersburg, FL 33702
(727) 570-9696

[cheese_breath]

I'll call the local Council on Aging. I'm trying right now to get a gameplan and figure everything out.

Don't mean to pile on, but the people you're not calling can help develop that gameplan.