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

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

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My mom is in the hospital now after she fell 2 weeks ago & never got any treatment then but the pain got so bad she must have fallen again & defecated all over herself & I found her sitting in it so I called paramedics to take her to the hospital.
So the ER doc told me that she will be there for a while, then I should consider putting mom in a nursing home since she shouldn't be living alone anymore & can't get around very well.
My mom receives Medicare & Medicaid.
Only $686 a month social security.
Has no savings, no other assets.
She does have a reverse mortgage on her home which is about 50% tapped out.
She can only get another $50,000 left from the RM.
Where can she go to live & get the care she needs after her hospitalization ?
I'm afraid because she is so low income that if its a nursing home it will be a bad one where patients are abused & mistreated.
Have heard horror stories & seen video of nursing home residents being battered by the staff, I don't want my mom to end up in a horrible place like that..
We live near Chicago.
Please help!!!

Medicaid

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

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

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

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

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

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

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

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

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

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

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

Grace + Peace,
Bob

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

Grace + Peace,
Bob

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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