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  1. #1
    div_0305 is online now Platinum level (1000+ posts)
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    Default First Question/Advice sought post!

    Greetings! I'm looking for an elder care professional to help me navigate care for my mom, age 73, with many physical and mental health issues. She has long term care, which has a lifetime max, and then very little in assets to pay for a nursing home/assisted living. An agent from the long term care company said to put her in the most $$$ assisted living/nursing home I can find that also takes Medicaid persons, and then when her lifetime max for the insurance policy runs out, the facility would have to keep her there under Medicaid whether they have a Medicaid bed available at that time or not. He says they can't force her out. I think he's wrong. I want to use her long term care benefits judiciously so they last as long as possible, and the cheaper nursing homes near me sound quite scary from the inspection reports. I'm extremely anxious about what happens if my mom is still alive when the LTC policy runs out, and how to coordinate/pay for her care. I cannot have her in my home--my children are very adversely affected by her mental issues, and I just can't imagine her in my house 24/7--as awful and ungrateful as that sounds, it's the simple hard truth.

    Right now she's in my dad's home, and being cared for by a caregiver that we pay through her LTC policy. He wants her out--they were separated, but never got divorced, and she's living in his house as a tenant somewhat. I know stranger yet. He's tired of having her there and has his own health issues. Before I pay an elder care attorney or consultant $$, any been there/done that advice? I know each situation is unique, but if you know the ins/outs of paying for continued care when a person has basically no assets left, please post. I don't want the constant guilt of putting her in a substandard nursing home, and think I'm missing some important part of the puzzle here for using Medicaid as best as possible for her. We are in VA --I know each state has discretion on how to administer Medicaid funds and programs.

  2. #2
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    I'm of no help but in a similar situation. My 72 yr old mom has no assets, spent all her retirement money, and lives off SS. She's in the process of getting diagnosed with what I think will be early stage dementia. She currently lives alone in a rental my sister pays for but she can't afford to do that forever. None of us kids want her living with us. I'm the oldest and feel the most responsible so I'm starting to research similar options so we are prepared when the time comes.

    Good luck OP it's so stressful!
    Mom of two girls and a boy

  3. #3
    lovin2shop is offline Sapphire level (2000+ posts)
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    I don't have any knowledge in this area, but the separated, but still married part caught my eye. If your parents stay married, won't your Dad's assets be counted against your mom such that she wouldn't be eligible for Medicaid when the policy runs out?

  4. #4
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    Quote Originally Posted by div_0305 View Post
    An agent from the long term care company said to put her in the most $$$ assisted living/nursing home I can find that also takes Medicaid persons, and then when her lifetime max for the insurance policy runs out, the facility would have to keep her there under Medicaid whether they have a Medicaid bed available at that time or not. He says they can't force her out.
    This is true AFAIK. I've also heard of people that 1. got admitted to hospital for minimum time (3 days?) Medicare requires to pay for rehab 2. discharge to nursing home for rehab which medicare pays for some period of time 3. continue to stay under medicaid.

    The part where she's still married seriously complicates things as well, esp since under some state's law, cohabiting even as "tenant" means they can't easily get divorced, if they went down that path.

    You really should talk to an attorney.
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  5. #5
    NCGrandma is online now Sapphire level (2000+ posts)
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    Quote Originally Posted by legaleagle View Post
    This is true AFAIK. I've also heard of people that 1. got admitted to hospital for minimum time (3 days?) Medicare requires to pay for rehab 2. discharge to nursing home for rehab which medicare pays for some period of time 3. continue to stay under medicaid..
    Like lots of long term care issues, this is definitely a "yes, but" situation. Yes, after a 3-day hospital stay (3 days of actual inpatient stay, not including ED/observation stays), Medicare will pay for rehab for up to 100 days (first 20 at 100%, then the rest with a copay). BUT, that is only true while the person is receiving rehab services AND continuing to show progress in rehab.

    My father was abruptly cut off from Medicare rehab coverage after only a short time when it was determined that his hip fracture repair had failed and that further rehab wasn't going to help him recover function. Ugh!


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  6. #6
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    I would recommend finding a Geriatric Nurse Case Manager. They are invaluable in helping you to navigate the system of elder care issues. My cousin is one in the Chicago area, but helped me as I cared for my Mom with multiple organ failure and my Dad with Alzheimer's for three years before they died.

    The information about long term care is correct - your mom cannot be thrown out when she becomes a Medicaid recipient if she has been a private pay resident previously.
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  7. #7
    div_0305 is online now Platinum level (1000+ posts)
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    Thanks everyone! I will doublecheck VA marriage law, however, my mom has 3-5 years of full time coverage if she goes to an assisted living/nursing home, so by then, we'd have enough time to have them get a divorce. I will talk with a Geriatric Nurse Care Manager--if I can avoid attorney's fees, I will!

    So if I get her into the best facility nearby which also takes Medicaid, it may be the best option long term. I guess I wonder what kind of bed/room she'd be moved to once she's no longer private pay.

    I need to visit the best of the worst around me--it's nerve wracking for me to read the inspection reports. I feel very sorry about not having a better solution up my sleeve. My mom did so much for us growing up despite very difficult circumstances. A string of unfortunate things has led her to become a different person, and too difficult to live with. With her mental issues, I could see her even making up abuse stories at a nursing home, and that would make things so much worse. I've seen careless, downright abusive nursing staff at a rehab center my dad was sent to after his heart attack--it really confirmed my worst fears of that type of environment.

  8. #8
    rlu is offline Ruby level (4000+ posts)
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    Quote Originally Posted by div_0305 View Post
    I need to visit the best of the worst around me--it's nerve wracking for me to read the inspection reports. I feel very sorry about not having a better solution up my sleeve. My mom did so much for us growing up despite very difficult circumstances. A string of unfortunate things has led her to become a different person, and too difficult to live with. With her mental issues, I could see her even making up abuse stories at a nursing home, and that would make things so much worse. I've seen careless, downright abusive nursing staff at a rehab center my dad was sent to after his heart attack--it really confirmed my worst fears of that type of environment.
    Start asking everyone you know if they have any btdt experience, including the people at school. The wider the pool, the more likely someone has experience. My mom was at two different rehab places over the last 5 years - one we would rec to people (also where my great-aunt spent her last years) and one we would not (the one that appeared nicer visually).
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  9. #9
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    Quote Originally Posted by NCGrandma View Post
    Like lots of long term care issues, this is definitely a "yes, but" situation. Yes, after a 3-day hospital stay (3 days of actual inpatient stay, not including ED/observation stays), Medicare will pay for rehab for up to 100 days (first 20 at 100%, then the rest with a copay). BUT, that is only true while the person is receiving rehab services AND continuing to show progress in rehab.

    My father was abruptly cut off from Medicare rehab coverage after only a short time when it was determined that his hip fracture repair had failed and that further rehab wasn't going to help him recover function. Ugh!
    Yes, always subject to caveats!

    OP - does your mother have a current Will/Powers of Attorney? If she doesn't your father would be the one to call the shots.
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  10. #10
    div_0305 is online now Platinum level (1000+ posts)
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    Quote Originally Posted by legaleagle View Post
    Yes, always subject to caveats!

    OP - does your mother have a current Will/Powers of Attorney? If she doesn't your father would be the one to call the shots.
    Thanks, yes, she does. I had a Will/Trust attorney do the will years ago, and I did a revised POA for her when they separated. I'm an attorney, so I can figure out how to do some of these things . If I wasn't already entrenched in my area of law, I'd switch to elder care. I see a huge, vast area of law that needs good practitioners.

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