Assisted living and Medicaid. Any advice?

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Assisted living and Medicaid. Any advice?

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My 80 yr old mom is currently in a rehab facility (after falling 3 weeks ago), she spent 3 days in the hospital (after being admitted from the ER), then transferred to rehab after her hospital stay.
As some of you may know my mom has no other assets other then get home which she has a reverse mortgage on.
Her limit (to draw anymore funds from her home is down to $48,000).
After that is gone, she has no other $ other then her paltry SocSec ($700/monthly).

My mom wants to desperately go back home to live but her imbalance issues are still what's preventing her from being able to walk unassisted & I am afraid she will be in danger if she goes back home (she lives alone) w/her small dog.
I live nearby but must work 6-7 days a week so I can't be there w/her for anything other then making daily stops to clean her house, do laundry, run errands, etc.
I don't not have a large income myself in order to help pay for 24 hour live in nursing care & even if I did, her house is not set up for that.
Would my mom be able to move into a "senior" building or is that called "assisted living" building so she can be in a smaller (apartment, since her house would be too much for her to maintain) and most important have a daily home visit from someone who works in that building?
Would Medicare and/or Medicaid (she has both) pay for that?
Thanks to all who respond.

Assisted Living

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Much depends on how she does in rehab. Assisted Living is covered by Medicaid, but not in all states. Talk to the discharge coordinator and the social worker about her progress or lack of it. It's too soon to tell what level of care she will need.

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My mom may be discharged next week (1/24) from the rehab place to go back home where she will be by herself.
I can't believe they think she is going to be alright alone & not fall (again) because she is still very unbalanced.
She has been in rehab for almost 3.5 weeks now but her she still uses the wheel chair to get around & on occasion will use the walker to go a very short distance to the bathroom (from her bed).
I asked the head nurse if anyone will come to see my mom at home & she said she'll probably get a visiting home aid once or twice a week who will stay for a few hours a day to do light housekeeping, prepare meals, etc.
But that's it??
What about her day to day care like bathing, physical therapy etc??
They know I work all day & into early evenings so I can be there w/mom for a lot of the time so how can they allow her to go back home when she's clearly not strong enough??

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I agree with tacy022. I would ask for an assessment and be present to ensure they are realistic. I would be clear that you cannot take care of her daily needs. You are working 6-7 days per week. To take care of all of her needs, besides a little outside help once per week, is rather unrealistic, especially, if she cannot get around unassisted.

I'd be frank about what the situation is. I would stress that she can't cook, do laundry, change linen, bathe, buy groceries, and that she is mostly immobile. I'm not sure sure how they think she's able to live alone. However, if a family member is there to say that they will do all those things for her, they will likely rely on your word.

I know that when a senior falls and is unsteady on their feet, has poor balance and continues to push it, then more fractures usually follow. They must know this too. I would ask that she apply for any and all benefits, including Medicaid, and see what she qualifies for.

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Your mother is mentally competent and does not want to move out of her home. You should fully utilize what help Medicaid will provide in terms of home health, and consider supplementing with private help from another home health agency for bathing and showers. Have the frank discussions with Mom about what is going to happen in the next few months. It has to happen and it is coming, but not straight from this rehab stay from what you say. Even if you try to maximize your reports of what she cannot do and you cannot do, I don't think she is going anywhere but home this time. This month, identify an AL which takes Medicaid and get her to agree to a move there, even if you have to endure more time in her own home. There will be a period of private pay and spend down as she will have to "sell" the home so there is paperwork on the business end to do, (sale of home, contract with assisted living) so you need the DPOA which you may already have. Most of all you have to stay persistent on the conversations with Mom which indicate that she has to move.

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Medicaid doesn't pay for assisted living facilities in most places. You would have to look at nursing homes. Medicare doesn't cover either. Medicare covers 21 days in a rehab.

People who are in assisted living, are paying for it themselves. I would look at decent nursing homes.

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But, people aren't accepted for admission to nursing homes unless they have the needs for the skilled nursing at the nursing home, her Mom does not sound as if she has those needs. Is that not true?

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It depends on the state she's in. I wasn't able to see where she is located, but in some states, such as NC, they have a program like Medicaid called Special Assistance. If you qualify for Medicaid medical, you most certainly will qualify for NC Special Assistance. It pays for Assisted Living for those who need it according to a doctor. So you if you need assistance with bathing, dressing, meals, medication, etc. you can qualify or if you are disabled. I would check with the applicable state's benefits to see what they offer.

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It all depends on the requirements and limitations of the state's home and community-based waiver program (the Medicaid waiver program for the elderly and disabled) I can say though that most state's HCBS waiver program does not cover assisted-living, just nursing home care and in-home care. Also, in most states, a skilled nursing level of care is not required. In fact, most people in nursing homes don't receive a whole lot of skilled nursing care. Instead, they receive what's called an intermediate level of nursing home care. This is largely personal care. (but if a person needs a lot of personal care then they may need to go into a NH) So, I would seek some local advice from your area agency on aging or if you can afford, an elder law attorney. This feels like to me a situation ripe for in-home care paid for by a Medicaid HCBS waiver.

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I want to have my mom move into an assisted living apartment.
We live in IL.
She has Medicare & Medicaid.
Only asset is her home which has a reverse mortgage.
That's almost gone w/$48,000 left to draw from.
Mom gets $753 monthly S.S & SSI.

So in order for my mom to go to an assisted living apartment, she would need to sell the house, pay back the reverse mortgage what is owed, then if any remaining $ from the sale, that would be taken by Medicaid so she can go live in assisted apartment??
Is that correct?

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That is largely correct. Illinois one of the few states that has a Medicaid assisted-living program. It's called SLF program for supportive living facility program. You'll want to look this up and contact the local administers of this program. But yes, essentially the participant needs to make payments to live in a SLF and the rules are pretty restrictive on whatever other assets they can keep.

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what if she didn't even have a home?

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Hangingon61, before you sell the house, look at the AL facilities near you and ask the financial questions when you go on the tour.
Also find out what she already owes to Medicaid vs what equity she has in the home. If it has been several years on Medicaid, I doubt if she has anything to gain from a sale. Plus, she may not want to move; you can't force her.

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debdaughter, if she does not have a home, that asset counts as zero.

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pam, I didn't the impression hangingon's mom has been on Medicaid; she's just been in rehab, so being paid for by Medicare and I understand in my situation she doesn't have an asset to count but I was more coming from the standpoint of the Medicaid Recovery Program where they can at least use your house to recover their expense but what if you don't have one?

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In Massachusetts, when enrolling in Medicaid, you are allowed $2, 000 in assets.

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Irishboy is right on both cases.

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OK just spoke w/Soc Services director @ moms rehab place & she invited me to a health conference next week to discuss all of my moms options & requirements that will be needed in order for her to return back to living in her home.

It is a given according to the director that my mom will quality for up to 40 hrs skilled nursing care to visit her once she moves back home because she does feel that my mom should NOT be left alone like she was prior to her last fall.
Her imbalance issues are too severe, even with using a walker (that's what she had been using & she still fell).

My biggest concern is moms house..
I want my mom to sell it & move to a smaller apartment.
Something much more manageable then her current home.
It's just too big.
Too many stairs, 2 floor & an uninhabitable basement (where her washer & dryer is), etc.

Not set up for a wheel chair to be moved around should she require that in the future, toilet not in good condition, etc.

But every time I suggest it to my mom, she gets EXTREMELY angry w/me & shuts the conversation down.

The social worker assured me that sometime would come out to the house prior to moms discharge to determine how much of a safety issues there will be for mom to be living there, & then she will stress to (mom) during our conference that if they determine it is unsafe for her to live there, then they will NOT discharge her & she will remain in the rehab facility..

So in other words, the suggestion to sell her house & move elsewhere more conducive to a better living environment would NOT be coming from me but rather the "professionals"..

Hopefully this will go well & I'm trying to be optimistic but I did tell the soc worker that I know my mom & her thinking so well, just like she knows me & she is going to put up one Hell of a "defense" when she hears these suggestions & will become very defensive like they are not giving her any choices, but "conspiring" to get her to move..

Anyone ever gone thru this scenario w/your parent??

Am I just being pessimistic in thinking that my mom is going to listen & consider their suggestions because it's coming from Them & not me??

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Illinois. In May 2014, the Center for Medicare and Medicaid Services approved the state’s request to implement a Managed Long Term Services and Support program (MLTSS) waiver to service the states dual eligible beneficiaries who choose to opt out of the Medicare-Medicaid Alignment Initiative (MMAI).
The program provides services on a mandatory bases for enrollees
residing in the Greater Chicago or Central Illinois area to participants who are 21 and older, entitled to benefits under Medicare Part A and enrolled under Medicare Parts B and D.
The program provides services to those receiving long term services based on the enrollee's need for nursing facility care. The MLTSS waiver will also provide benefits to enrollees who participate in one of the five1915 (c) waivers.

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https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/Downloads/ILMOU.pdf

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sounds very similar to the contracted program with the VA for Home and Community bases services - but I was expecting that the 40 hrs. was per week, not a maximum total - wrong?

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this is having to be certified through a doctor, now, too, correct?

Also in my situation I think she's possibly in Medicaid spend-down mode

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I am currently in battle about the medicaid HBC, waivers, Community First Choice, specifically in home attendant, family being paid as caregivers and many other services to dementia victims and family.
I have discovered that the federal government gets the blame for things that are not right, but in fact, our representatives have for decades legislated some wonderful support. Our representatives continue to amend rules, daily to our advantage. The feds either share costs with the state or often even entirely fund the 'services'. The feds often even fund the state's administration costs, but the state agencies and plan carriers tend to use 'latitude' and 'options' to illicitly make their own rules ..uh... 'policies' for their profit and convenience.
My fair hearing is solidly based on the state government workers frequent statement, "we don't follow all the federal rules, we have our own policies". And "yes there is a contract with the plan provider, the insurance company, but we 'give them latitude'.
Give 'latitude' to the entity that can most profit by exploiting us?
The best example is when I read in the federal code about services we are suppose to be receiving under the Social Security 1915 acts, the state official said "but we operate under the 1115", to make me believe that they didn't have to follow federal regulations. I researched the 1115 demonstration and it is contrary to what he was implying. The 1115 brings many of the benefits that have been established for DD, developmentally disabled, to the aging and disabled. It expands on the 1915 acts and does not limit in any way for us. The limits are placed on the state government to 'waive' the regulations that restrict the services only to certain groups to include us in the services. This can be internet searched on the 1115 waiver demonstration and Community First Choice. I won 2 fair hearings and DHS conceded 2 others in another state because I learned the state administrative code which directed me to the federal codes. Now I am fighting this state and it is the same. This state's administrative code is primitive by comparison but I know this."Unless a rule is explicity waived and published in the 'Federal Register', the state will follow the federal rule.
Summary. The health plan provider will manipulate for profit. The state workers at all levels will be complicit by ignorance, complacency or for bonuses, either monetary or accolades. Do not just accept their decision. They do not want you to know. Challenge them.
Do know that it is difficult to find an attorney with experience in these matters.
CMS.gov is the best source of information because of who they are.
Be aware that there are some differences in Medicare and Medicaid.

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My example that I will win. My wife is not 65 so Medicaid covers. Her disease causes her to be 'hellish'. No institution can handle her without restraint and sedation. I can, I have since 2011, and I want to, care for her at home. (Even in her most hellish moments, I would rather deal with her than anyone in the agencies that are supposed to help).
One of our state's options is Community First Choice. In that, my wife can receive in home care up to 100% of what it would cost to place her in an institution. She requires 24/7 watch. The insurer is only paying 31.5 hours per week attendant care, so all the other 136.5 hours are on me. My wife does not sleep much so neither do I.
The attendant works 4.5 hours per day to give me a break. So I read in the state's contract with the insurer, that if 24/7 'supervisory' is required, the attendant hours BEGIN at 55 hours. The rest depends on the voluntary support only for the hours that exceed the cost of institutionalization. Up to that the insurer is to provide attendants.
The insurer had 'latitude' to calculate that based on assisted living of 3k per month, and the insurer, for their gain did not even calculate near the 100% rule. Reality is that my wife would require a 10k per month facility and at $20 per hour including agency fee, that would allow for 2 attendants for 8.3 hours per day each, 7 days per week. Exactly right.
2 shifts 7 days or however divided with more workers and I would volunteer the 3rd shift.
Medicaid - Home Based Care - Community First Choice Option

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EllerySir, forgive me but most of what you wrote & posted while appreciated is very confusing to me & I don't understand it..
:(

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Hangingon61,
I read your post update about the social worker. I'm trying to understand how a caretaker who comes in 40 hours per week is supposed to help a senior who cannot walk unassisted and who has balance problems. What does she do when they leave for the day? And who does her shopping, laundry, cooking, etc.? I'm not sure these people who will be assessing the home get it. Do they really think that she is able to transfer herself, get up and down ramps, get to the bathroom during the night and care for her little dog on her own? I'd have a huge list prepared and be ready to challenge things that don't seem right.

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Yes, Sunnygirl exactly what you mentioned.
I'm thinking they expect me to stay w/my mom or care for her the other hours or times that the aid is not w/her & that's just not possible because I work so many hours & won't be able to get any sleep if I go to stay w/mom during the 3rd shift (12am-8am).
So this has me very concerned.

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hangingon, I think Ellery's trying to say you might have to fight this; happened with hub's aunt and uncle over PT but couldn't get her to understand it either, be glad to try to help if you can explain what you don't understand

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I didn't say much more because I don't know where in IL you live

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Debdaughter we live in a burb of Chicago.

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The state administering program gives a 'capitated', a set amount for each person to the health plan. UHC is a popular one. Say they get $5000 a month to provide services to each person. 100 people is $500,000.
For HBC, they are to compare cost of nursing home to keep at home. The state tells UHC what services to provide, such as PT, attendants, homemakers. UHC is contracted to provide authorized services up to that amount of 5000 per person. It is possible that a hard case, needy client, will use all of that, but UHC makes that up with the client that only needs $1000 service.
UHC get to keep the other $4000.
Of course they will try to deny or limit services such as attendant care. They are not allowed to, but they are finding ways by manipulating definitions and clauses, and mostly by not informing you of how it works.
In my state, the case manager is an employee of the plan provider.
Conflict of interest much?

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Assisted living and Medicaid. Any advice?

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