[Medicaid nursing home for mother]

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[Medicaid nursing home for mother]

Post by Vanguard User »

Are Medicaid nursing homes just as good as out of pocket ones?


[ClaycordJCA’s moderator’s note: New topic split from Subject: Long Term Care Medicaid financial considerations]
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arcticpineapplecorp.
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Re: Long Term Care Medicaid financial considerations

Post by arcticpineapplecorp. »

Vanguard User wrote: Tue Mar 14, 2023 8:02 pm Are Medicaid nursing homes just as good as out of pocket ones?
where i live there is only one non medicaid nursing home. All the others (there are dozens) accept medicaid after you exhaust most of your resouces and then qualify for medicaid. the home is the same. i assume the care is the same. the difference is the pricetag. those paying privately are sort of subsidizing those that are on medicaid (because of the much lower medicaid reimbursement rate). Nursing homes would go out of business if they had no private pay clients; they couldn't afford to be fiscally viable on what medicaid pays. Most nursing homes where I am have a certain number of medicaid beds available with the rest being private pay. You can have private rooms vs. semi private rooms when paying privately, as opposed to medicaid beds which are mainly shared rooms, but that's the only difference I see.
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Re: Long Term Care Medicaid financial considerations

Post by Vanguard User »

arcticpineapplecorp. wrote: Tue Mar 14, 2023 9:34 pm
Vanguard User wrote: Tue Mar 14, 2023 8:02 pm Are Medicaid nursing homes just as good as out of pocket ones?
where i live there is only one non medicaid nursing home. All the others (there are dozens) accept medicaid after you exhaust most of your resouces and then qualify for medicaid. the home is the same. i assume the care is the same. the difference is the pricetag. those paying privately are sort of subsidizing those that are on medicaid (because of the much lower medicaid reimbursement rate). Nursing homes would go out of business if they had no private pay clients; they couldn't afford to be fiscally viable on what medicaid pays. Most nursing homes where I am have a certain number of medicaid beds available with the rest being private pay. You can have private rooms vs. semi private rooms when paying privately, as opposed to medicaid beds which are mainly shared rooms, but that's the only difference I see.
Will my mother be able to get it for free meaning everything covered if she needs it? She has no assets. Only income is SSI (less than $800) and SNAP. We are in Houston, TX suburb area.

Do I need to hire a lawyer to process this? What is the timeline looking like and is there a waitlist to admit her?
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arcticpineapplecorp.
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Re: Long Term Care Medicaid financial considerations

Post by arcticpineapplecorp. »

Vanguard User wrote: Wed Mar 15, 2023 5:20 pm
arcticpineapplecorp. wrote: Tue Mar 14, 2023 9:34 pm
Vanguard User wrote: Tue Mar 14, 2023 8:02 pm Are Medicaid nursing homes just as good as out of pocket ones?
where i live there is only one non medicaid nursing home. All the others (there are dozens) accept medicaid after you exhaust most of your resouces and then qualify for medicaid. the home is the same. i assume the care is the same. the difference is the pricetag. those paying privately are sort of subsidizing those that are on medicaid (because of the much lower medicaid reimbursement rate). Nursing homes would go out of business if they had no private pay clients; they couldn't afford to be fiscally viable on what medicaid pays. Most nursing homes where I am have a certain number of medicaid beds available with the rest being private pay. You can have private rooms vs. semi private rooms when paying privately, as opposed to medicaid beds which are mainly shared rooms, but that's the only difference I see.
Will my mother be able to get it for free meaning everything covered if she needs it? She has no assets. Only income is SSI (less than $800) and SNAP. We are in Houston, TX suburb area.

Do I need to hire a lawyer to process this? What is the timeline looking like and is there a waitlist to admit her?
if her income and assets are as you say they are, then you don't need a lawyer, nor can she afford one. If she's on SSI and SNAP she's likely getting regular medicaid as well (known as a buyin):

https://www.google.com/search?client=fi ... ome+is+SSI

you say she has no assets, but she probably has a bank account where SSI is deposited unless she has some kind of direct express or other debit card.

in the event she has a bank account I'm not sure how texas does it. The long term care resource limit in texas seems to be $2000 and the resource limit for SSI is $2000 so I'm not sure if Texas would ask for bank statements or not during the lookback period (5 years prior to skilled care). In my state we do, because at times we find that a client on SSI has more than $2000 in the bank, when they're not supposed to for SSI (but SSA doesn't know and/or it wasn't reported to them). The caseworker at the State will explain what's needed. To be on the safe side, you could start keeping bank statements in the event you have to produce them for the caseworker at the State.
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Re: Long Term Care Medicaid financial considerations

Post by Vanguard User »

arcticpineapplecorp. wrote: Wed Mar 15, 2023 5:34 pm
Vanguard User wrote: Wed Mar 15, 2023 5:20 pm
arcticpineapplecorp. wrote: Tue Mar 14, 2023 9:34 pm
Vanguard User wrote: Tue Mar 14, 2023 8:02 pm Are Medicaid nursing homes just as good as out of pocket ones?
where i live there is only one non medicaid nursing home. All the others (there are dozens) accept medicaid after you exhaust most of your resouces and then qualify for medicaid. the home is the same. i assume the care is the same. the difference is the pricetag. those paying privately are sort of subsidizing those that are on medicaid (because of the much lower medicaid reimbursement rate). Nursing homes would go out of business if they had no private pay clients; they couldn't afford to be fiscally viable on what medicaid pays. Most nursing homes where I am have a certain number of medicaid beds available with the rest being private pay. You can have private rooms vs. semi private rooms when paying privately, as opposed to medicaid beds which are mainly shared rooms, but that's the only difference I see.
Will my mother be able to get it for free meaning everything covered if she needs it? She has no assets. Only income is SSI (less than $800) and SNAP. We are in Houston, TX suburb area.

Do I need to hire a lawyer to process this? What is the timeline looking like and is there a waitlist to admit her?
if her income and assets are as you say they are, then you don't need a lawyer, nor can she afford one. If she's on SSI and SNAP she's likely getting regular medicaid as well (known as a buyin):

https://www.google.com/search?client=fi ... ome+is+SSI

you say she has no assets, but she probably has a bank account where SSI is deposited unless she has some kind of direct express or other debit card.

in the event she has a bank account I'm not sure how texas does it. The long term care resource limit in texas seems to be $2000 and the resource limit for SSI is $2000 so I'm not sure if Texas would ask for bank statements or not during the lookback period (5 years prior to skilled care). In my state we do, because at times we find that a client on SSI has more than $2000 in the bank, when they're not supposed to for SSI (but SSA doesn't know and/or it wasn't reported to them). The caseworker at the State will explain what's needed. To be on the safe side, you could start keeping bank statements in the event you have to produce them for the caseworker at the State.
She has UHC dual complete which is Medicare and Medicaid combined.

She just has a checking account where the direct deposit of SSI goes. She only keep less then $20 every month in her bank.
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Re: Long Term Care Medicaid financial considerations

Post by Jovby »

Vanguard User wrote: Wed Mar 15, 2023 5:20 pm
Will my mother be able to get it for free meaning everything covered if she needs it? She has no assets. Only income is SSI (less than $800) and SNAP. We are in Houston, TX suburb area.

Do I need to hire a lawyer to process this? What is the timeline looking like and is there a waitlist to admit her?
If she is on SSI then she already has medicaid. Getting in to a decent nursing home on medicaid can be challenging depending on the area. Her best bet would be to admit to the nursing home from a hospital on medicare for rehab, and then just never leave.
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Re: Long Term Care Medicaid financial considerations

Post by Vanguard User »

Jovby wrote: Thu Mar 16, 2023 6:20 pm
Vanguard User wrote: Wed Mar 15, 2023 5:20 pm
Will my mother be able to get it for free meaning everything covered if she needs it? She has no assets. Only income is SSI (less than $800) and SNAP. We are in Houston, TX suburb area.

Do I need to hire a lawyer to process this? What is the timeline looking like and is there a waitlist to admit her?
If she is on SSI then she already has medicaid. Getting in to a decent nursing home on medicaid can be challenging depending on the area. Her best bet would be to admit to the nursing home from a hospital on medicare for rehab, and then just never leave.
Medicare doesn’t cover 100% though?
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Re: Long Term Care Medicaid financial considerations

Post by arcticpineapplecorp. »

Vanguard User wrote: Thu Mar 16, 2023 8:43 pm
Jovby wrote: Thu Mar 16, 2023 6:20 pm
Vanguard User wrote: Wed Mar 15, 2023 5:20 pm
Will my mother be able to get it for free meaning everything covered if she needs it? She has no assets. Only income is SSI (less than $800) and SNAP. We are in Houston, TX suburb area.

Do I need to hire a lawyer to process this? What is the timeline looking like and is there a waitlist to admit her?
If she is on SSI then she already has medicaid. Getting in to a decent nursing home on medicaid can be challenging depending on the area. Her best bet would be to admit to the nursing home from a hospital on medicare for rehab, and then just never leave.
Medicare doesn’t cover 100% though?
No it does not. It may cover 100% of the first 20 days if in SNF for rehab only. Then it only covers a portion of the next 100 days or so. If in SNF for long term you get a medicare cut letter which means medicare will not cover your long term stay.
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Jovby
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Re: Long Term Care Medicaid financial considerations

Post by Jovby »

Vanguard User wrote: Thu Mar 16, 2023 8:43 pm
Medicare doesn’t cover 100% though?
Medicare part A covers nursing home care for rehab (physical, occupational, speech therapy) and skilled nursing (IV antibiotics, wound care, tube feeding ect). Medicare covers 100% of the first 20 days, and another 80 days with a $200 / day copay (copay covered by Medicaid/coinsurance).

After the rehab or skilled nursing is over (either because you don’t need it, or you hit the 100 days) then you transition to custodial care which is NOT covered by Medicare. At that point Medicaid would begin paying as primary.

The nursing home is NOT allowed to kicked you out, as long as they accept payment from Medicaid. Therefore you can end up at a fairly decent skilled nursing facility for custodial care under Medicaid. If you were to apply to that same nursing home for custodial care under Medicaid from the beginning, they would not accept you and say they “don’t have beds.” The truth is they have beds, they are just reserving those beds for rehab/skilled nursing patients because the pay is so much higher.

My recommendation if your loved one is being referred to a nursing home for rehab or skilled nursing, is to make sure they accept Medicaid, and also that it’s a good facility you wouldn’t mind them staying in long term. That way you have the option of them staying if needed.
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Re: Long Term Care Medicaid financial considerations

Post by Carefreeap »

arcticpineapplecorp. wrote: Thu Mar 16, 2023 9:02 pm
Vanguard User wrote: Thu Mar 16, 2023 8:43 pm
Jovby wrote: Thu Mar 16, 2023 6:20 pm
Vanguard User wrote: Wed Mar 15, 2023 5:20 pm
Will my mother be able to get it for free meaning everything covered if she needs it? She has no assets. Only income is SSI (less than $800) and SNAP. We are in Houston, TX suburb area.

Do I need to hire a lawyer to process this? What is the timeline looking like and is there a waitlist to admit her?
If she is on SSI then she already has medicaid. Getting in to a decent nursing home on medicaid can be challenging depending on the area. Her best bet would be to admit to the nursing home from a hospital on medicare for rehab, and then just never leave.
Medicare doesn’t cover 100% though?
No it does not. It may cover 100% of the first 20 days if in SNF for rehab only. Then it only covers a portion of the next 100 days or so. If in SNF for long term you get a medicare cut letter which means medicare will not cover your long term stay.
That wasn't the case with my father. But that was CA and Medicaid is very state specific. He went from SNF on one side of the facility to medicaid custodial care on the other side of the building. Prior to him breaking ribs (three falls within 18 months) I was told from various social workers that there was an approximately two year waiting list to find space. I don't know for a fact but I suspect that being already at the facility helped. Also I should note this wasn't the first time. We had attempted to get him into AL but that didn't even last a month because they couldn't care for him as promised.

I do recommend the OP consult with an elder care atty to figure out options. Usually the atty will have a paralegal who knows how to navigate the system. Alternatively you'll just have to do what the rest of us wind up doing...wait for the fall crisis to happen and hope for the best. :oops:
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Re: [Medicaid nursing home for mother]

Post by HomeStretch »

Does your mother need a skilled nursing facility (SNF) now or are you asking for the future?

Does she have dementia or require assistance with multiple daily living activities which would make her eligible for Medicaid long-term care benefits in a SNF? Some states also provide financial assistance, if eligible, for other types of facilities (for example, assisted living) or in-home care.

If you foresee your mom needing care in-home or at a facility, it’s good to do some pro-active planning such as checking out facilities, getting on waiting lists and becoming familiar with financial assistance programs. Your biggest hurdles will likely be lack of funds, identifying good facilities and being admitted quickly at the time it is needed. Also, your mom’s willingness to accept care may be an issue.

In my area there are 2-3 year waits for Day 1 Medicaid patients at the better SNFs that accept Medicaid assignment. You can jump the admissions waiting list at most by agreeing to private pay for a period of time. There are availability issues too due to high demand at better facilities. In my parent’s case, it was 1 year of private pay for $240k. My parent was lucky to be admitted as a private-pay patient after a 3-week wait for an opening.

Best of luck. Your mom is lucky to have your help and that you are asking these questions on her behalf.
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Re: Long Term Care Medicaid financial considerations

Post by Vanguard User »

arcticpineapplecorp. wrote: Thu Mar 16, 2023 9:02 pm
Vanguard User wrote: Thu Mar 16, 2023 8:43 pm
Jovby wrote: Thu Mar 16, 2023 6:20 pm
Vanguard User wrote: Wed Mar 15, 2023 5:20 pm
Will my mother be able to get it for free meaning everything covered if she needs it? She has no assets. Only income is SSI (less than $800) and SNAP. We are in Houston, TX suburb area.

Do I need to hire a lawyer to process this? What is the timeline looking like and is there a waitlist to admit her?
If she is on SSI then she already has medicaid. Getting in to a decent nursing home on medicaid can be challenging depending on the area. Her best bet would be to admit to the nursing home from a hospital on medicare for rehab, and then just never leave.
Medicare doesn’t cover 100% though?
No it does not. It may cover 100% of the first 20 days if in SNF for rehab only. Then it only covers a portion of the next 100 days or so. If in SNF for long term you get a medicare cut letter which means medicare will not cover your long term stay.
What was the hospital thing you were talking about? Is that a hack?
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Re: Long Term Care Medicaid financial considerations

Post by Vanguard User »

Jovby wrote: Fri Mar 17, 2023 10:08 am
Vanguard User wrote: Thu Mar 16, 2023 8:43 pm
Medicare doesn’t cover 100% though?
Medicare part A covers nursing home care for rehab (physical, occupational, speech therapy) and skilled nursing (IV antibiotics, wound care, tube feeding ect). Medicare covers 100% of the first 20 days, and another 80 days with a $200 / day copay (copay covered by Medicaid/coinsurance).

After the rehab or skilled nursing is over (either because you don’t need it, or you hit the 100 days) then you transition to custodial care which is NOT covered by Medicare. At that point Medicaid would begin paying as primary.

The nursing home is NOT allowed to kicked you out, as long as they accept payment from Medicaid. Therefore you can end up at a fairly decent skilled nursing facility for custodial care under Medicaid. If you were to apply to that same nursing home for custodial care under Medicaid from the beginning, they would not accept you and say they “don’t have beds.” The truth is they have beds, they are just reserving those beds for rehab/skilled nursing patients because the pay is so much higher.

My recommendation if your loved one is being referred to a nursing home for rehab or skilled nursing, is to make sure they accept Medicaid, and also that it’s a good facility you wouldn’t mind them staying in long term. That way you have the option of them staying if needed.
My goal is to get her a permanent home that is private and/or shared close to my home if needed down the road.

How do I know which homes are good for her? This would be to assist her with daily activities and dementia.
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Re: Long Term Care Medicaid financial considerations

Post by cheese_breath »

Vanguard User wrote: Fri Mar 17, 2023 7:41 pm
Jovby wrote: Fri Mar 17, 2023 10:08 am
Vanguard User wrote: Thu Mar 16, 2023 8:43 pm
Medicare doesn’t cover 100% though?
Medicare part A covers nursing home care for rehab (physical, occupational, speech therapy) and skilled nursing (IV antibiotics, wound care, tube feeding ect). Medicare covers 100% of the first 20 days, and another 80 days with a $200 / day copay (copay covered by Medicaid/coinsurance).

After the rehab or skilled nursing is over (either because you don’t need it, or you hit the 100 days) then you transition to custodial care which is NOT covered by Medicare. At that point Medicaid would begin paying as primary.

The nursing home is NOT allowed to kicked you out, as long as they accept payment from Medicaid. Therefore you can end up at a fairly decent skilled nursing facility for custodial care under Medicaid. If you were to apply to that same nursing home for custodial care under Medicaid from the beginning, they would not accept you and say they “don’t have beds.” The truth is they have beds, they are just reserving those beds for rehab/skilled nursing patients because the pay is so much higher.

My recommendation if your loved one is being referred to a nursing home for rehab or skilled nursing, is to make sure they accept Medicaid, and also that it’s a good facility you wouldn’t mind them staying in long term. That way you have the option of them staying if needed.
My goal is to get her a permanent home that is private and/or shared close to my home if needed down the road.

How do I know which homes are good for her? This would be to assist her with daily activities and dementia.
Medicare.gov has ratings, but they seem to change often. I suggest paying them surprise visits to see how they do when they're not expecting you.
The surest way to know the future is when it becomes the past.
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arcticpineapplecorp.
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Re: Long Term Care Medicaid financial considerations

Post by arcticpineapplecorp. »

Vanguard User wrote: Fri Mar 17, 2023 7:34 pm
arcticpineapplecorp. wrote: Thu Mar 16, 2023 9:02 pm
Vanguard User wrote: Thu Mar 16, 2023 8:43 pm
Jovby wrote: Thu Mar 16, 2023 6:20 pm
Vanguard User wrote: Wed Mar 15, 2023 5:20 pm
Will my mother be able to get it for free meaning everything covered if she needs it? She has no assets. Only income is SSI (less than $800) and SNAP. We are in Houston, TX suburb area.

Do I need to hire a lawyer to process this? What is the timeline looking like and is there a waitlist to admit her?
If she is on SSI then she already has medicaid. Getting in to a decent nursing home on medicaid can be challenging depending on the area. Her best bet would be to admit to the nursing home from a hospital on medicare for rehab, and then just never leave.
Medicare doesn’t cover 100% though?
No it does not. It may cover 100% of the first 20 days if in SNF for rehab only. Then it only covers a portion of the next 100 days or so. If in SNF for long term you get a medicare cut letter which means medicare will not cover your long term stay.
What was the hospital thing you were talking about? Is that a hack?
no hack, just know the rules:
Skilled nursing facility (SNF) care
Medicare Part A (Hospital Insurance)
covers skilled nursing care

for a limited time (on a short-term basis) if all of these conditions apply:

You have Part A and have days left in your benefit period
to use.

You have a qualifying inpatient hospital stay
.
Note
During the COVID-19 pandemic, some people may be able to get renewed SNF coverage without first having to start a new benefit period.
If you’re not able to be in your home during the COVID-19 pandemic or are otherwise affected by the pandemic, you can get SNF care without a qualifying hospital stay.
Your doctor has decided that you need daily skilled care. You must get the care from, or under the supervision of, skilled nursing or therapy staff.
You get these skilled services in a Medicare-certified SNF.
You need these skilled services for a medical condition that’s either:
A hospital-related medical condition treated during your qualifying 3-day inpatient hospital stay (not including the day you leave the hospital), even if it wasn't the reason you were admitted to the hospital.
A condition that started while you were getting care in the SNF for a hospital-related medical condition (for example, if you develop an infection that requires IV antibiotics while you're getting SNF care)
.

Your costs in Original Medicare

You pay this for each benefit period:

Days 1–20: $0 coinsurance
per day
Days 21–100: Up to $200 coinsurance
per day
Days 101 and beyond: All costs

Note

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.
What it is

Skilled care is nursing and therapy care that can only be safely and effectively performed by, or under the supervision of, professionals or technical personnel. It’s health care given when you need skilled nursing or skilled therapy to treat, manage, and observe your condition, and evaluate your care.

Medicare-covered services in a skilled nursing facility include, but aren't limited to:

A semi-private room (a room you share with other patients)
Meals
Skilled nursing care
Physical therapy (if needed to meet your health goal)
Occupational therapy (if needed to meet your health goal)
Speech-language pathology services (if they're needed to meet your health goal)
Medical social services
Medications
Medical supplies and equipment used in the facility
Ambulance transportation (when other transportation endangers your health) to the nearest supplier of needed services that aren’t available at the SNF
Dietary counseling

Things to know

Learn more about the situations that may impact your coverage and costs.

source: https://www.medicare.gov/coverage/skill ... y-snf-care
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Topic Author
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Re: Long Term Care Medicaid financial considerations

Post by Vanguard User »

cheese_breath wrote: Fri Mar 17, 2023 7:47 pm
Vanguard User wrote: Fri Mar 17, 2023 7:41 pm
Jovby wrote: Fri Mar 17, 2023 10:08 am
Vanguard User wrote: Thu Mar 16, 2023 8:43 pm
Medicare doesn’t cover 100% though?
Medicare part A covers nursing home care for rehab (physical, occupational, speech therapy) and skilled nursing (IV antibiotics, wound care, tube feeding ect). Medicare covers 100% of the first 20 days, and another 80 days with a $200 / day copay (copay covered by Medicaid/coinsurance).

After the rehab or skilled nursing is over (either because you don’t need it, or you hit the 100 days) then you transition to custodial care which is NOT covered by Medicare. At that point Medicaid would begin paying as primary.

The nursing home is NOT allowed to kicked you out, as long as they accept payment from Medicaid. Therefore you can end up at a fairly decent skilled nursing facility for custodial care under Medicaid. If you were to apply to that same nursing home for custodial care under Medicaid from the beginning, they would not accept you and say they “don’t have beds.” The truth is they have beds, they are just reserving those beds for rehab/skilled nursing patients because the pay is so much higher.

My recommendation if your loved one is being referred to a nursing home for rehab or skilled nursing, is to make sure they accept Medicaid, and also that it’s a good facility you wouldn’t mind them staying in long term. That way you have the option of them staying if needed.
My goal is to get her a permanent home that is private and/or shared close to my home if needed down the road.

How do I know which homes are good for her? This would be to assist her with daily activities and dementia.
Medicare.gov has ratings, but they seem to change often. I suggest paying them surprise visits to see how they do when they're not expecting you.
Visit nursing home after my mother is admitted?
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cheese_breath
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Re: Long Term Care Medicaid financial considerations

Post by cheese_breath »

Vanguard User wrote: Fri Mar 17, 2023 11:06 pm
cheese_breath wrote: Fri Mar 17, 2023 7:47 pm
Vanguard User wrote: Fri Mar 17, 2023 7:41 pm
Jovby wrote: Fri Mar 17, 2023 10:08 am
Vanguard User wrote: Thu Mar 16, 2023 8:43 pm
Medicare doesn’t cover 100% though?
Medicare part A covers nursing home care for rehab (physical, occupational, speech therapy) and skilled nursing (IV antibiotics, wound care, tube feeding ect). Medicare covers 100% of the first 20 days, and another 80 days with a $200 / day copay (copay covered by Medicaid/coinsurance).

After the rehab or skilled nursing is over (either because you don’t need it, or you hit the 100 days) then you transition to custodial care which is NOT covered by Medicare. At that point Medicaid would begin paying as primary.

The nursing home is NOT allowed to kicked you out, as long as they accept payment from Medicaid. Therefore you can end up at a fairly decent skilled nursing facility for custodial care under Medicaid. If you were to apply to that same nursing home for custodial care under Medicaid from the beginning, they would not accept you and say they “don’t have beds.” The truth is they have beds, they are just reserving those beds for rehab/skilled nursing patients because the pay is so much higher.

My recommendation if your loved one is being referred to a nursing home for rehab or skilled nursing, is to make sure they accept Medicaid, and also that it’s a good facility you wouldn’t mind them staying in long term. That way you have the option of them staying if needed.
My goal is to get her a permanent home that is private and/or shared close to my home if needed down the road.

How do I know which homes are good for her? This would be to assist her with daily activities and dementia.
Medicare.gov has ratings, but they seem to change often. I suggest paying them surprise visits to see how they do when they're not expecting you.
Visit nursing home after my mother is admitted?
Both before and after. Surprise visit before to see how they treat the patients when nobody is watching. Regular visits after to ensure she's being cared for properly, and to provide a little cheer in her life by your presence.
The surest way to know the future is when it becomes the past.
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Re: Long Term Care Medicaid financial considerations

Post by Vanguard User »

cheese_breath wrote: Sat Mar 18, 2023 9:09 am
Vanguard User wrote: Fri Mar 17, 2023 11:06 pm
cheese_breath wrote: Fri Mar 17, 2023 7:47 pm
Vanguard User wrote: Fri Mar 17, 2023 7:41 pm
Jovby wrote: Fri Mar 17, 2023 10:08 am

Medicare part A covers nursing home care for rehab (physical, occupational, speech therapy) and skilled nursing (IV antibiotics, wound care, tube feeding ect). Medicare covers 100% of the first 20 days, and another 80 days with a $200 / day copay (copay covered by Medicaid/coinsurance).

After the rehab or skilled nursing is over (either because you don’t need it, or you hit the 100 days) then you transition to custodial care which is NOT covered by Medicare. At that point Medicaid would begin paying as primary.

The nursing home is NOT allowed to kicked you out, as long as they accept payment from Medicaid. Therefore you can end up at a fairly decent skilled nursing facility for custodial care under Medicaid. If you were to apply to that same nursing home for custodial care under Medicaid from the beginning, they would not accept you and say they “don’t have beds.” The truth is they have beds, they are just reserving those beds for rehab/skilled nursing patients because the pay is so much higher.

My recommendation if your loved one is being referred to a nursing home for rehab or skilled nursing, is to make sure they accept Medicaid, and also that it’s a good facility you wouldn’t mind them staying in long term. That way you have the option of them staying if needed.
My goal is to get her a permanent home that is private and/or shared close to my home if needed down the road.

How do I know which homes are good for her? This would be to assist her with daily activities and dementia.
Medicare.gov has ratings, but they seem to change often. I suggest paying them surprise visits to see how they do when they're not expecting you.
Visit nursing home after my mother is admitted?
Both before and after. Surprise visit before to see how they treat the patients when nobody is watching. Regular visits after to ensure she's being cared for properly, and to provide a little cheer in her life by your presence.
When my uncle was there. He had dementia. We had to sign in at the front desk to see him.
Last edited by Vanguard User on Sat Mar 18, 2023 4:35 pm, edited 1 time in total.
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Squirrel208
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Re: [Medicaid nursing home for mother]

Post by Squirrel208 »

This recent AP article on Medicaid-funded long-term care appears to be on topic:
In nursing homes, impoverished live final days on pennies
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cheese_breath
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Re: [Medicaid nursing home for mother]

Post by cheese_breath »

Squirrel208 wrote: Sat Mar 18, 2023 12:08 pm This recent AP article on Medicaid-funded long-term care appears to be on topic:
In nursing homes, impoverished live final days on pennies
Thank you for that article Squirrel. Something everyone who's contemplating putting a loved one om Medicaid should read.
The surest way to know the future is when it becomes the past.
prd1982
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Re: [Medicaid nursing home for mother]

Post by prd1982 »

cheese_breath wrote: Sat Mar 18, 2023 12:27 pm
Squirrel208 wrote: Sat Mar 18, 2023 12:08 pm This recent AP article on Medicaid-funded long-term care appears to be on topic:
In nursing homes, impoverished live final days on pennies
Thank you for that article Squirrel. Something everyone who's contemplating putting a loved one om Medicaid should read.
I don't see how this is related to being on long term care Medicaid. Can't the family still give the person money?
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cheese_breath
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Re: [Medicaid nursing home for mother]

Post by cheese_breath »

prd1982 wrote: Sat Mar 18, 2023 12:36 pm
cheese_breath wrote: Sat Mar 18, 2023 12:27 pm
Squirrel208 wrote: Sat Mar 18, 2023 12:08 pm This recent AP article on Medicaid-funded long-term care appears to be on topic:
In nursing homes, impoverished live final days on pennies
Thank you for that article Squirrel. Something everyone who's contemplating putting a loved one om Medicaid should read.
I don't see how this is related to being on long term care Medicaid. Can't the family still give the person money?
What the family can and can't do depends on the individual state's rules
The surest way to know the future is when it becomes the past.
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Squirrel208
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Re: [Medicaid nursing home for mother]

Post by Squirrel208 »

prd1982 wrote: Sat Mar 18, 2023 12:36 pm
cheese_breath wrote: Sat Mar 18, 2023 12:27 pm
Squirrel208 wrote: Sat Mar 18, 2023 12:08 pm This recent AP article on Medicaid-funded long-term care appears to be on topic:
In nursing homes, impoverished live final days on pennies
Thank you for that article Squirrel. Something everyone who's contemplating putting a loved one om Medicaid should read.
I don't see how this is related to being on long term care Medicaid. Can't the family still give the person money?
The answer to that varies depending on each state's Medicaid rules, and the purpose and amount of the gifts. See this article for a general discussion on the topic, including an overview of state-by-state rules: Risks of Giving Money to Families on Medicaid
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Re: Long Term Care Medicaid financial considerations

Post by cheese_breath »

Vanguard User wrote: Sat Mar 18, 2023 11:47 am
cheese_breath wrote: Sat Mar 18, 2023 9:09 am
Vanguard User wrote: Fri Mar 17, 2023 11:06 pm
cheese_breath wrote: Fri Mar 17, 2023 7:47 pm
Vanguard User wrote: Fri Mar 17, 2023 7:41 pm

My goal is to get her a permanent home that is private and/or shared close to my home if needed down the road.

How do I know which homes are good for her? This would be to assist her with daily activities and dementia.
Medicare.gov has ratings, but they seem to change often. I suggest paying them surprise visits to see how they do when they're not expecting you.
Visit nursing home after my mother is admitted?
Both before and after. Surprise visit before to see how they treat the patients when nobody is watching. Regular visits after to ensure she's being cared for properly, and to provide a little cheer in her life by your presence.
When my uncle was there. He had dementia. We had to sign in at the front desk to see him everyone.
If you arrive unannounced and tell the front desk you'd like a tour because you're looking for a nursing home for a family member, they probably won't turn you away. Be suspicious if they tell you to schedule a tour for later. There may be things going on at that time they don't want you to see.
The surest way to know the future is when it becomes the past.
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Re: [Medicaid nursing home for mother]

Post by prd1982 »

Squirrel208 wrote: Sat Mar 18, 2023 12:54 pm The answer to that varies depending on each state's Medicaid rules, and the purpose and amount of the gifts. See this article for a general discussion on the topic, including an overview of state-by-state rules: Risks of Giving Money to Families on Medicaid
Thanks. I want to note that the article states that the table only relates to assisted living and not nursing homes. I find that confusing since I didn’t think assisted listing was covered by Medicaid.

Maryland says “NO”, but I will be checking with social services. Note that I’m only interested in small items, not room upgrades, etc.
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Squirrel208
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Re: Long Term Care Medicaid financial considerations

Post by Squirrel208 »

Vanguard User wrote: Sat Mar 18, 2023 11:47 am
cheese_breath wrote: Sat Mar 18, 2023 9:09 am
Vanguard User wrote: Fri Mar 17, 2023 11:06 pm
cheese_breath wrote: Fri Mar 17, 2023 7:47 pm
Vanguard User wrote: Fri Mar 17, 2023 7:41 pm

My goal is to get her a permanent home that is private and/or shared close to my home if needed down the road.

How do I know which homes are good for her? This would be to assist her with daily activities and dementia.
Medicare.gov has ratings, but they seem to change often. I suggest paying them surprise visits to see how they do when they're not expecting you.
Visit nursing home after my mother is admitted?
Both before and after. Surprise visit before to see how they treat the patients when nobody is watching. Regular visits after to ensure she's being cared for properly, and to provide a little cheer in her life by your presence.
When my uncle was there. He had dementia. We had to sign in at the front desk to see him everyone.
This is typical security protocol and has nothing to do with thwarting unannounced visits from family members who are responsible for the resident's care etc. Memory care and other assisted living facilities have a duty to protect and monitor anyone coming through their entrances. This is to protect both the facility and their residents. The primary reason is the legal requirement to account for all occupants of the building in event of any unexpected emergency, such as fire etc. Secondary reasons include tracking visitors to manage patient care, prevent fraud and elder abuse, and for patient managers to have visibility to visitation information that they might not otherwise be informed of.

If your family member isn't currently a resident of the facility, or if you don't have legal authority to manage your family member's care, then you can expect to be challenged by staff to prove your identity and be properly escorted during any visit... surprise or not. In this case it's also unlikely that you'd be granted visitation access outside of normal visitation hours unless permission was secured ahead of time.

Some facilities utilize a computerized Visitor Management System (VMS) rather than a paper logbook at the front desk etc. I was responsible for my father's care during his final declining months as he battled dementia at a memory care facility that used a VMS system. During orientation I was issued a unique RFID security card, assigned permanently to me for the duration of dad's stay, which I could then use to enter the facility 24/7 by swiping it at any of scanners on locked doors that were appropriate for my authorized level of security.

I lived nearby and visited frequently at all hours of the day, 7 days a week. I saw a lot of things that I'll never be able to unsee, because dealing with dementia patients is just as challenging for them as it is for family members, if not more so. (There's a special place waiting in heaven for those caregivers IHMO.) But I never once felt that I stumbled into an awkward or otherwise inappropriate care moment, or that staff was alert to my presence and on-guard for the same.

Just my own experience, and I know that the culture in all facilities isn't necessarily the same. Yet another reason to consider eschewing Medicaid-funded elder care in favor of private care facilities when financially feasible. You get what you pay for, or don't get what you don't pay for, and all that...
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Re: [Medicaid nursing home for mother]

Post by Vanguard User »

prd1982 wrote: Sat Mar 18, 2023 12:36 pm
cheese_breath wrote: Sat Mar 18, 2023 12:27 pm
Squirrel208 wrote: Sat Mar 18, 2023 12:08 pm This recent AP article on Medicaid-funded long-term care appears to be on topic:
In nursing homes, impoverished live final days on pennies
Thank you for that article Squirrel. Something everyone who's contemplating putting a loved one om Medicaid should read.
I don't see how this is related to being on long term care Medicaid. Can't the family still give the person money?
If they want to.
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Re: [Medicaid nursing home for mother]

Post by Vanguard User »

Squirrel208 wrote: Sat Mar 18, 2023 12:54 pm
prd1982 wrote: Sat Mar 18, 2023 12:36 pm
cheese_breath wrote: Sat Mar 18, 2023 12:27 pm
Squirrel208 wrote: Sat Mar 18, 2023 12:08 pm This recent AP article on Medicaid-funded long-term care appears to be on topic:
In nursing homes, impoverished live final days on pennies
Thank you for that article Squirrel. Something everyone who's contemplating putting a loved one om Medicaid should read.
I don't see how this is related to being on long term care Medicaid. Can't the family still give the person money?
The answer to that varies depending on each state's Medicaid rules, and the purpose and amount of the gifts. See this article for a general discussion on the topic, including an overview of state-by-state rules: Risks of Giving Money to Families on Medicaid
It has to be taxable money otherwise no one knows.
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Re: Long Term Care Medicaid financial considerations

Post by Vanguard User »

cheese_breath wrote: Sat Mar 18, 2023 1:12 pm
Vanguard User wrote: Sat Mar 18, 2023 11:47 am
cheese_breath wrote: Sat Mar 18, 2023 9:09 am
Vanguard User wrote: Fri Mar 17, 2023 11:06 pm
cheese_breath wrote: Fri Mar 17, 2023 7:47 pm
Medicare.gov has ratings, but they seem to change often. I suggest paying them surprise visits to see how they do when they're not expecting you.
Visit nursing home after my mother is admitted?
Both before and after. Surprise visit before to see how they treat the patients when nobody is watching. Regular visits after to ensure she's being cared for properly, and to provide a little cheer in her life by your presence.
When my uncle was there. He had dementia. We had to sign in at the front desk to see him everyone.
If you arrive unannounced and tell the front desk you'd like a tour because you're looking for a nursing home for a family member, they probably won't turn you away. Be suspicious if they tell you to schedule a tour for later. There may be things going on at that time they don't want you to see.
Oh ok.
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Re: [Medicaid nursing home for mother]

Post by beyou »

Question, is it really necessary to keep 5 years of bank/broker statements to qualify for Medicaid LT care ?
Meaning can Medicaid just contact your bank/broker and get the records with your permission, or just you save all bank/broker statements essentially forever to have the latest 5 year rolling statements ? I understand the purpose of a look back, just wondering about the logistics.

We are just now moving my MIL $ to a trust, and wondering if we must now start keeping her personal non-trust statements every month and produce them all in 5+ years ?
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Re: [Medicaid nursing home for mother]

Post by Katietsu »

Talk to every 50 to 65 year old that you know. There will be a good chance that some have been part of the process with a parent. I have experience with a nursing home that will only accept private pay or direct from hospital transfers but then keeps you in the same room after you transition to medicaid. Another relative was in a perfectly acceptable facility which accepted patients regardless of the type of payment and all were treated equally. Another facility had two wings and I was shocked when I wandered in to the medicaid wing. I am not suggesting neglect but it was dismal compared to the other side of the building. And then there are just a couple facilities where I have witnessed truly poor care. There seems to be only a loose connection between quality of care and cost in my area. You can make a meaningful difference by spending time researching options.
HomeStretch
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Re: [Medicaid nursing home for mother]

Post by HomeStretch »

beyou wrote: Sat Mar 18, 2023 4:49 pm Question, is it really necessary to keep 5 years of bank/broker statements to qualify for Medicaid LT care ?
Meaning can Medicaid just contact your bank/broker and get the records with your permission, or just you save all bank/broker statements essentially forever to have the latest 5 year rolling statements ? I understand the purpose of a look back, just wondering about the logistics.

We are just now moving my MIL $ to a trust, and wondering if we must now start keeping her personal non-trust statements every month and produce them all in 5+ years ?
Your state website will tell you the paper document support that must be submitted as part of the application. I am in the middle of a state review of my parent’s Medicaid LTC benefit application. Yes, I had to provide personal documents, support for every asset, 5 years of statements for every account, support for every receipt/disbursement/transfer/gift during the 5-year period for $5,000+ including individual!credit charge statement items for $5,000+. The caseworker reviewing the application can and has asked for documentation for items <$5,000.

No, my parent’s caseworker will not obtain any documents directly from banks and brokerages. The onus is on the applicant to provide everything.

Allow sufficient time to gather the documentation.
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Re: [Medicaid nursing home for mother]

Post by TexasPE »

beyou wrote: Sat Mar 18, 2023 4:49 pm ... wondering if we must now start keeping her personal non-trust statements every month and produce them all in 5+ years ?
Check with an eldercare attorney https://www.naela.org/findlawyer
I am aware of a family attorney who cost a friend's aunt $100,000+ by not understanding the spend-down requirements and exemptions in Texas.

Every state is different regarding Medicaid rules. An eldercare attorney can answer your questions for your state.

A suggestion:

see whether the facility has a family council. I joined the one at my mother's facility. The council met monthly, and gave family the opportunity to raise issues and also learn what management is dealing with.
At 20: I cared what everyone thought about me | At 40: I didn't give a damn what anyone thought of me | Now that I'm 60: I realize that no one was really thinking about me at all | Winston Churchill (?)
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beyou
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Re: [Medicaid nursing home for mother]

Post by beyou »

HomeStretch wrote: Sat Mar 18, 2023 5:06 pm
beyou wrote: Sat Mar 18, 2023 4:49 pm Question, is it really necessary to keep 5 years of bank/broker statements to qualify for Medicaid LT care ?
Meaning can Medicaid just contact your bank/broker and get the records with your permission, or just you save all bank/broker statements essentially forever to have the latest 5 year rolling statements ? I understand the purpose of a look back, just wondering about the logistics.

We are just now moving my MIL $ to a trust, and wondering if we must now start keeping her personal non-trust statements every month and produce them all in 5+ years ?
Your state website will tell you the paper document support that must be submitted as part of the application. I am in the middle of a state review of my parent’s Medicaid LTC benefit application. Yes, I had to provide personal documents, support for every asset, 5 years of statements for every account, support for every receipt/disbursement/transfer/gift during the 5-year period for $5,000+ including individual!credit charge statement items for $5,000+. The caseworker reviewing the application can and has asked for documentation for items <$5,000.

No, my parent’s caseworker will not obtain any documents directly from banks and brokerages. The onus is on the applicant to provide everything.

Allow sufficient time to gather the documentation.
So how does one gather 5 years worth of statements.
Most banks show last year of statements maybe. Do people pay banks to retrieve from archives ?
prd1982
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Re: [Medicaid nursing home for mother]

Post by prd1982 »

beyou wrote: Sat Mar 18, 2023 8:00 pm
So how does one gather 5 years worth of statements.
Most banks show last year of statements maybe. Do people pay banks to retrieve from archives ?
I just went thru it. The bank had 7 years of PDFs. Fortunately the Medicaid group has a web site where you can upload the PDFs of all the supporting documentation. I also needed a year of utility bills. I had bought a laser print cartridge that I fortunately didn’t need.
HomeStretch
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Re: [Medicaid nursing home for mother]

Post by HomeStretch »

beyou wrote: Sat Mar 18, 2023 8:00 pm So how does one gather 5 years worth of statements.
Most banks show last year of statements maybe. Do people pay banks to retrieve from archives ?
It took a couple months to gather everything. I downloaded account and credit card statements monthly for my parents as their POA for the last 7 years. So I had some of the documents. For any that were missing, I contacted the issuer.

I went through my parents files to get copies of the personal documents - birth certificates, insurance cards, etc. plus asset titles and receipts for large purchases. I had to contact a few places (car and stairlift dealers) to get duplicate receipts.
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Re: [Medicaid nursing home for mother]

Post by beyou »

HomeStretch wrote: Sat Mar 18, 2023 8:26 pm
beyou wrote: Sat Mar 18, 2023 8:00 pm So how does one gather 5 years worth of statements.
Most banks show last year of statements maybe. Do people pay banks to retrieve from archives ?
It took a couple months to gather everything. I downloaded account and credit card statements monthly for my parents as their POA for the last 7 years. So I had some of the documents. For any that were missing, I contacted the issuer.

I went through my parents files to get copies of the personal documents - birth certificates, insurance cards, etc. plus asset titles and receipts for large purchases. I had to contact a few places (car and stairlift dealers) to get duplicate receipts.
Wow, seems like just an obstacle to reduce successful applications.
Katietsu
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Re: [Medicaid nursing home for mother]

Post by Katietsu »

TexasPE wrote: Sat Mar 18, 2023 5:59 pm
beyou wrote: Sat Mar 18, 2023 4:49 pm ... wondering if we must now start keeping her personal non-trust statements every month and produce them all in 5+ years ?
Check with an eldercare attorney https://www.naela.org/findlawyer
I am aware of a family attorney who cost a friend's aunt $100,000+ by not understanding the spend-down requirements and exemptions in Texas.
I am not sure an elder care attorney would be the right person. Mom has no assets and is already medicare/medicaid dual eligible. Unless there are pieces missing in this story, the types of things that an elder care attorney typically does is not relevant here.
fposte
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Re: Long Term Care Medicaid financial considerations

Post by fposte »

Vanguard User wrote: Fri Mar 17, 2023 7:41 pm
My goal is to get her a permanent home that is private and/or shared close to my home if needed down the road.

How do I know which homes are good for her? This would be to assist her with daily activities and dementia.
The Medicaid necessity will limit your choices, especially if she's a direct admit on Medicaid. Start by investigating facilities near you and finding out their Medicaid policies and whether they're accepting new patients currently. Then assess the ones that fit the category. In my area, there are only three that accept direct Medicaid admits, so it may simplify your choice considerably.

One possible starting resource is this search tool from the American Council on Aging.
maroon
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Re: [Medicaid nursing home for mother]

Post by maroon »

This is very slightly off-topic, but I'm acquainted with someone on Medicaid who was in assisted living and now needs a Medicaid-accepting nursing home w/ memory care services. This person (via a POA) has applied to 15+ memory-care nursing homes and has been accepted by a total of 1. However, that 1 particular facility supposedly has a horrible reputation, so the family ended up taking the person home and is now providing 24-hour care. I guess my point is that it may not be super easy to find a nursing home that accepts Medicaid and has beds available, perhaps moreso if memory care is needed. Best wishes to you and your mother.
Last edited by maroon on Sun Mar 19, 2023 12:01 pm, edited 2 times in total.
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Re: Long Term Care Medicaid financial considerations

Post by Vanguard User »

fposte wrote: Sun Mar 19, 2023 9:41 am
Vanguard User wrote: Fri Mar 17, 2023 7:41 pm
My goal is to get her a permanent home that is private and/or shared close to my home if needed down the road.

How do I know which homes are good for her? This would be to assist her with daily activities and dementia.
The Medicaid necessity will limit your choices, especially if she's a direct admit on Medicaid. Start by investigating facilities near you and finding out their Medicaid policies and whether they're accepting new patients currently. Then assess the ones that fit the category. In my area, there are only three that accept direct Medicaid admits, so it may simplify your choice considerably.

One possible starting resource is this search tool from the American Council on Aging.
Thanks.
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Re: [Medicaid nursing home for mother]

Post by Vanguard User »

maroon wrote: Sun Mar 19, 2023 11:57 am This is very slightly off-topic, but I'm acquainted with someone on Medicaid who was in assisted living and now needs a Medicaid-accepting nursing home w/ memory care services. This person (via a POA) has applied to 15+ memory-care nursing homes and has been accepted by a total of 1. However, that 1 particular facility supposedly has a horrible reputation, so the family ended up taking the person home and is now providing 24-hour care. I guess my point is that it may not be super easy to find a nursing home that accepts Medicaid and has beds available, perhaps moreso if memory care is needed. Best wishes to you and your mother.
Reviews are not always accurate. Generally, people like to post negative reviews. Few bad experiences.
maroon
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Re: [Medicaid nursing home for mother]

Post by maroon »

Vanguard User wrote: Sun Mar 19, 2023 12:00 pm
maroon wrote: Sun Mar 19, 2023 11:57 am This is very slightly off-topic, but I'm acquainted with someone on Medicaid who was in assisted living and now needs a Medicaid-accepting nursing home w/ memory care services. This person (via a POA) has applied to 15+ memory-care nursing homes and has been accepted by a total of 1. However, that 1 particular facility supposedly has a horrible reputation, so the family ended up taking the person home and is now providing 24-hour care. I guess my point is that it may not be super easy to find a nursing home that accepts Medicaid and has beds available, perhaps moreso if memory care is needed. Best wishes to you and your mother.
Reviews are not always accurate. Generally, people like to post negative reviews. Few bad experiences.
I'm not super close to this situation, but I understand the family did not base their decision from online reviews (though the online reviews weren't great, either). Anyway, I think fposte's comment above is quite applicable/helpful.
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