Happy5 Asked February 2016
When someone goes into a nursing home does their Medicare cover the entire cost or will there be out of pocket expense also?
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I work full time and have been spending the night with my Mom to make sure she takes her Meds and I also prepare breakfast for her before I leave for work each morning. She has Leukemia and is severely anemic. She has received treatments/transfusions for the past year and not showing any lasting benefit. She has severe Osteoporosis with multiple compression fractures in her spine and has COPD. She has very little appetite for the past 3 weeks and eats only a few bites of soft food at a time. If the time comes for a Nursing Home does Medicare/Medicaid cover the entire cost? We live in Oklahoma.
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About M &Ms, Medicaid will pay for NH if mom meets the "at need" requirement to be medically at need for skilled nursing care & at need financially which means impoverished. Now they can have their home and a car as an exempt asset under Medicaid. BUT due to the required co-pay or SOC, she will have no -nada - zero of her $ to pay on anything " house" anymore. The way your post reads it sounds like you are going and spending the night at moms house, is that right? If so, you need to think hard about what to do with the house. Most of the time, the house gets sold and so mom has assets to pay for NH so won't qualify or requalify for medicaid till she spends the funds down to be impoverished again.
Medicare only pays for medical costs like MD, hospitalization, health care providers like PT or OT. Medicare pays for hospice. Medicare pays for RXs depending on their Medicare drug plan. Medicare does NOT pay for long term care or it's room & board costs in a NH but Medicaid will pay if they qualify both financially & medically to be "at need" for a NH.
Pam's idea of getting her evaluated for hospice is spot on. She could likely qualify and you coukd have at home hospice coming in a few hours every week while you & mom work out the many details On getting her qualified for Medicaid, dealing with her home; finding a NH suited for her needs; spending down $, etc before ever doing the Medicaid applications.
Hospice as its a Medicare benefit is self directed so mom or you as her DPOA can select the vendor. Not all hospice are alike. There are bigger nationwide companies like Vitas & Compassus and then small local ones. The bigger ones usually have the staffing ability to get equipment ordered and installed ASAP (like speciality beds). Some are nonprofit, some for profit. Some have a special bent like oncology care. You can shop around for hospice & then change providers if thet are not a good fit. I changed my moms hospice company within her first 90 day first eligibility period.
They can be on hospice and be in a NH on Medicaid at the same time as well. It's been my experience that a NH really loves, loves, loves this as hospice provides for extra hands to help in caregiving (especially the bathing & sanitary supplies & obtaining higher end nutitionals aspects) without being a cost to the NH.
Ask her MD to write orders for hospice evaluation to start the process on this.
If she is not eating, ask your MD if it is time for Hospice services. You can also call Hospice yourself and they will come to the home for an evaluation of need.