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I'll be contacting the SNF tomorrow (for what it's worth because I get the run around or wrong info) but my sister's 100th day is 6 days away. I just figured they would move her to another room, thinking rehab rooms were separate from LTC. I don't know exact layout of facility because I just go to her room when visiting, but I do recognize some patients that must be LTC residents because they're sitting in an open area on the way to my sister's room. I'm not POA and my sister doesn't have any copies of any documents and says she hasn't signed anything. She does get confused, and she can really tune out real-world things, but she doesn't have a mental disorder or anything diagnosed. She's basically immobile, incontinent, multiple health issues that started with morbid obesity leading to diabetes, blood clots, congenital heart failure, etc. I am her point of contact with the facility, but they haven't filled me in on what happens next. Thanks for your help.

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In the facility where my LO is, the rehab rooms are a separate wing. Their rehab rooms are much more hotel-like and I believe all of them are private rooms. I'm thinking this is due to the presumably temporary nature of a rehab stay. I'm also assuming there is money to be made from rehab rooms and patient referrals to such rooms, so there is definitely more of a resort type of feel to the rehab rooms. The nursing home section is a lot more old-school stereotype and hospital-like. However, it is clean and appropriate for the type of care provided there.

When my LO's rehab ended (well short of the 100 or so days we thought she was getting - I know better now.....) we knew we could not bring her home due to her condition. She became private pay in that moment and quickly became Medicaid Pending through no small feat on my part.

She WAS moved to a different wing of the same building - although she argued that she was actually across the street in a different facility.... hence at least part of the reason she could not be brought home. I think it was a little loosey-goosey on getting her moved to the nursing home room due to room availability, etc. As long as the billing is correct for the nursing home 2-person room rate and you are not being overcharged a cash price for a rehab room, the exact time frame of the move isn't so important.

We did not initially tell our LO that she was never coming home. We told her there was a room change coming up due to her insurance requirements.
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Contact the administration of the facility. Ask for a meeting to discuss your sister's progress and further care. Tell them your sister asked you to be there for the meeting with her. Make a list of questions together with your sister about every aspect of her care. Sometimes, "skilled nursing" are in different rooms from "rehab." Sometimes it is the same place. It depends on the facility.
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kibrij: I did see your update of May 4. Best of luck.
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My mom was in a TCU. After 100 days, she was moved to Long Term Care.
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"In Maryland you can't submit the application until you've reached the asset limit (2,500 or less)."

This does not seem logical. This means the NH will need to wait for their money and no assurance Sister will be OKd. I live in NJ. You have 90 days to SPEND DOWN assets, get info needed to them and place the person. You can read my previous reply on how everything was handled. Went right from private pay into Medicaid. Its always been, in NJ anyway, get that application stared before money runs out.

Have you been given this information by someone at the Rehab? If so, I would call your County Social Service office and talk to a Medicaid caseworker to confirm what you have been told. If the info is wrong, I would not use that facility to do the application. It was done between me and the Medicaid caseworker.
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Finally got a reply from staff and have a meeting scheduled with the facility 2 days from now, which happens to be Day #99. My sister does know & realize that the level of care she needs can only be provided in a NH. We did start off slow with breaking the news a little over a month ago, and built on it until she rationally came to terms with it. But it's heartbreaking because she had opportunities to get stronger; we all were hoping... She has enough funds to pay the 1st two months as a private pay resident in a shared room, and then she'll apply for Medicaid. In Maryland you can't submit the application until you've reached the asset limit (2,500 or less). The co-insurance was $194.50 per day for days 21-100, that was a big chunk. The facility isn't in a very convenient location for most of us to visit and once she's on Medicaid the plan is to try to get her somewhere closer. Thanks for all your advice & encouragement.
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My dad was in the snf for rehab they moved him to ltc in the nh wing. I was wondering since you said you really haven’t talked to anyone if they have explained how Medicare works. Medicare only pays 100% for the first 20 days for days 21-100 you have to pay a copay of 194.50 a day. I don’t know if she has been in a snf already this year but in order to get Medicare to pay a new benefit period there has to be 60 days in between each occurrence and have stayed 3 consecutive days in the hospital. Then Medicare will start a new benefit period where they will pay a 100% for the first 20 days and then days 21-100 there is a copay of 194.50. The other thing is that a lot of ltc facilities won’t take a person that has not already been approved for Medicaid anymore, they used to take them as long as you could prove that they had applied but there are to many of them that have gotten burned that way because some people don’t get approved. Also I was wondering why your sister isn’t going to apply for Medicaid for 2 months after she goes into ltc? Does she have to spendown to $2,000? As soon as she leaves rehab she goes off Medicare she is private pay. My dad went to long term care September 20,2021 and my mom had to start private pay that day. So needless to say her first bill was quite expensive, plus the nh bills a month ahead. It usually takes three to four months to get approved for Medicaid and that was before covid. I know all this information isn’t to your actual question I just wanted to make sure you knew how things worked in case nobody has told you there. Wishing you and your sister the best.

P.S. if she is going on Medicaid she has to have at least a double room.
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jonessu May 2022
Yep, Medicare only pays if there is a chance you will get better. Once you are not, you are on your own… time to private pay and/or liquidate private assets and apply for Medicaid. I think if more people understood this fact, they might prepare earlier in life and/or push for social programs that support this time in folks’ lives.
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Your second to last sentence says it all, she will now be a resident of the facility. They probably have not told her as to not upset her. They'll probably move her as soon as the 100 days are up.
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Does this particular SNF have long term care?
The POA not being in place this will be difficult.
Discharge planners will be reaching out to family soon. They often can get a temporary POA or guardianship if Sister isn't able to participate.
Sounds as though placement will be needed. I am really sorry that it has come to the end of stay to address the needs ongoing; just responded the same to another poster on the Forum moments ago. That honestly isn't your problem, but the problem of the facility which should have addressed next of kin in the case that Sis can't make her own decisions.
Call Discharge planning/Social Services today with your concerns. Tell them all you have told us.
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In the Rehabs in my area the Rehab wing is separate from the NH part of the facility. So, when rehab is done you are transported to the NH wings. The only time this would not happen is if there are no beds available in the NH wing. Then u stay on the rehab side till there is.

You do need to know if she is transferred. I say this because you want to be there when they do so your sisters belongings go with her. Take an inventory now by taking pictures of everything. So if something is missing u have a picture to prove it.

You apply for Medicaid before her money runs out. For my Mom she had enough money to private pay for 2 months. Mid April I applied for Medicaid. Mom went into the NH on May 1st paying May and June. June I confirmed with the caseworker that I had spent down Moms money and given them all the info needed. Medicaid started July 1st. My State only gives 90 days to spend down, get them info needed and place the person.

If the NH is helping with the application be involved. Keep up with everything they are doing. Know who the caseworker is. You have a right to make sure the NH is doing their job. Me, I don't trust people to do their jobs so I do as much as I can and keep on top of things.
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My mother started out in a room at SN on the rehab wing. This was after a serious septic infection for which she was hospitalized and she has never been able to walk since. Then after a few weeks she was moved to another wing and private pay began. This was all in the winter of 2020. In August of 2021 she was dropped and both her femurs were broken. She did receive 100 days of Medicare pay then. She stayed in that same second room where she still is today. You can't believe how difficult it was to get her paper marked with the present newer room number. Countless calls but finally it was changed so I didn't have to go chase down her paper and at times kindly ask the resident in her former room if I could have my mother's paper.

I believe this will be her permanent room for the duration of her life. If she outlives her present funds I will have to figure out a solution then but it is too sad now to see her in her present state to overly contemplate that as that situation is not imminent.
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kibrij May 2022
I can hear the frustration and sadness in your words, it really is difficult to not be discouraged. That's why this forum is such a bright spot for me in this situation. Knowledge & compassion served daily, so grateful.
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When my mom went to rehab at a sNF, she stayed on in the same room, same bed when she switched over to being a private pay LTC resident.

We chose at that time to move her to a shared room because it was less lonely.
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kibrij May 2022
My sister is in a shared room now, since she's been there she's had 3 different roomates and also some of that time (100 days) she had the room to herself. She likes the company for the most part. When she starts private pay, it would also be for a shared room, that's the intent anyway - just don't have any paperwork that shows that, nothing has been signed in relation to the switch from rehab to ltc.
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If she is Medicaid or Medicaid pending, then yes they usually require that a roommate moves in if a double room, or that the resident move to a double room.
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kibrij May 2022
Yes, she currently is in a shared room now, with Medicare, but will be private pay once the 100 days is over, and will apply for Medicaid after 2 months. I was curious about what other people have experienced, to get an idea of how soon they might be moving her from the rehab portion of SNF to the LTC portion. I'll be calling them today anyway. Thanks.
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