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about the charge for the shower. State regulations require "X" number of showers per week. (I was surprised to find this out and in Illinois it is 2 showers per week) If MIL got an extra shower I can understand the fee. And if it took a caregiver (aide) away from doing someone else's shower that could make them out of compliance. Personally I would be more upset that someone was fired because of the request not the $75.00 fee. As to the fee that is charged if you write a check. many places will charge fees if you use a credit card and write a check or an e-check". There is more "work" involved. Generally an automatic payment does not garner the "processing fee". $50.00 seems excessive to me. But both processing fees and convenience fees are legal you might want to check your state and see if there is a maximum amount that can be charged. It also sounds to me that MIL's needs are not being met and maybe she should not be in AL but rather Skilled Nursing. I would be concerned with can they deal with problems that might arise after insulin has been given. I would be looking for a place that can better serve her needs.
MILHell, the situation at the AL is not ever going to get better. They are clueless and incompetent. To me the overriding issue is that your MILs level of care - insulin by injection, pain medication, transition needed - is beyond what this AL can provide or is willing to provide and what is happening to MIL - RXs not being dispensed as per script, bodily fluids and fecal matter left on skin - is actually causing or will cause serious medical issues to happen. It is not a safe place for MIL.
im kinda wondering if all this obvious incompetence is being done deliberately….. that the AL has found themselves with a resident whose care needs are way way beyond what the staff at a AL can provide. That someone cocked up badly in allowing MIL to reside there. It appears They are doing stuff that makes it difficult to be in compliance for payment so can use that as a pretext to send you all a Notice to Move and then the horrid care situation is going to lead to a care crisis… like wound care needed from the crap show MiL sat in, or some sort of diabetic crisis. Most AL do not ever have the need to have lower rate paid room&board LTC Medicaid beds to run their place; there are plenty of folks who have the private pay funds to pay for AL care; AL don’t need to rely on finding impoverished residents who can be on Medicaid.
The only time I’ve seen an AL ever having LTC Medicaid beds that provided a more skilled level of care was at a facility that was tiered, so went from IL to AL to NH or AL to NH. The AL side had just a few LTC Medicaid beds and they all were basically placeholder beds till someone in a Medicaid bed on the NH side died and then that AL Medicaid resident moved over to the NH. There was continuity of care easily happening as Nh staff could come over and do things. Freestanding AL just are not staffed to be able to provide lots of hands on care; AL “assisting” is more about helping them in daily life activities, like zipping up back of a dress, assisting in transition in the shower, helping them in&out of the shopping trip van. LTC Medicaid pays a fixed low rate, if MiL needs loads of staff time - which it seems she does - she’s a drag on their staffing for other residents. Paying extra for medication management is kinda standard for an AL to charge. But dealing with a resident who need daily insulin and whatever else her diabetes management needs is imho beyond the wheelhouse for AL.
what would be simplest plan would be for there to be something that staff notices that seem to be such that a trip to the ER / ED is warranted and so EMS is called; MiL gets transported over to the ER at a hospital (not a UrgiClinic type of place but ER at a full fledged hospital); ER evaluates her and she gets admitted to the hospital; and then the AL refuses to take her back (they will say “we cannot meet the level of care for her); then the discharge planner at the hospital will then have to find her a place & it will be in a NH as Mil has serious diabetes needs plus whatever else will be in that now nice & fat chart from her ER and hospital stay; that Mil is already on LTC Medicaid will be a big plus for a Nh as they know the $ flow will not be an issue.
TIA aka transient ischemic attack is often used as a reason to call EMS. TIAs are really subjective as to how they present. It’s easy for an elder who is ill or with dementia to look odd enough to have had a TIA. & 99.9% of the time the EMS will load them up and take them to the ER.
ThIs AL is not going to get better and neither is the level of care your MIL needs. Try to get her out, into a hospitalization stay (Medicare pays) and then discharged for rehab (MediCARE pays) at a NH then she stays permanently at the NH (goes back onto LTC Medicaid). Really stay focused to get beyond this clusterF of a AL and get MIL into a Medicaid bed in a NH soon. Good luck.
igloo572 - you totally and accurately described the care level differences received between AL and LTC facilities. This is exactly what we encountered with our mother who initially was in AL independent level. I observed bare basics provided for cleaning apartment and residents got them self to the dining room 3 times daily. Those who used their medication dispense program paid extreme fees where they went to the nurse office to get their daily medications dispensed. Staff did NOT go to their room to give daily medications. There was no nurse staff in the building at night time either.
It was when our mother was admitted to ER and hospital for UTI infection followed by rehab - who confirmed she required much higher care level then provided in AL. The Rehab confirmed there was NO way she could return to her independent AL apartment with no one checking her multiple times per day, giving daily medications and meals, cleaning / dressing and getting her to toilet. No way could AL provide that level of care. Those care level requirements are the differences as to where the elder person needs to reside.
Last night when husband went to do the insulin shot, mother in law told him there was an envelope for him.
On Thursday, she had an appointment and he asked that she get her shower before the appoimtment rather than after dinner that day. He was told it was not a problem by the aide.
The aide was fired because it was not approved by management and we now have a $75 bill.
I, highly recommend, that your husband contacts the police the next time he finds her soaking wet and untended. This is actually neglect and is elder abuse.
By law the facility has to provide a detailed list of charges. They can't just help themselves to her money or charge extra.
I would tell the stupid sob that is telling you no to a Zelle payment is actually telling you they won't accept a ACH payment. It's a no fee transfer that is the same as an autopay and that's what ACH is, it doesn't give them access to take her money, it's a clearing house.
I think they don't know what they are talking about and from everything you have shared, they are guilty of elder abuse and are now trying to set it up for financial abuse.
Everyone that visits and finds her uncared for and sitting in a dirty diaper needs to contact the police, every single time.
This senior residence does not sound like a safe environment for your LO. My understanding is that only nurses are legally allowed to administer medication to patients - NOT aides. That in itself sounds like a huge legal liability for this facility. I'm guessing there are differences between states in regards to a ALF versus a SNF.
My limited experience with ALF is a resident is evaluated on a care level scale for how independent they can function. I don't know what the policy was for private duty nurses as my mother was transferred to a SNF when her care level needs increased. It was obvious the ALF could not provide that care level. SNF is required to have a nurse staff 24/7 which was not required in the ALF. Basically residents wore an ALERT bracelet and if they triggered it during the night then some night shift person would check in the room and call an ambulance. However, no one checked the residents during the night - they were basically shut in their apartments. The ALERT bracelet is only useful if the patient is actually able to use it during a health crisis.
The fee has nothing to do with medicaid. Are you trying to set up a bank transfer paying for someone's Assisted Living or LTC room and board charge.
Yes, in some instances there is a charge for doing this by the bank. Seems the AL is being charged by their bank to do this transaction so they are sending that cost onto the resident.
How are you doing this, wiring the money? Are they trying to set up automatic withdrawal? Your LO is on Medicaid and you are trying to set up somekind of withdrawal of their SS check to offset the care.
Is the resident going to live the rest of their life in this facility. If so, why not allow the facility to become ur LOs payee. The only problem would be, if they are willing to set up a personal needs acct for the small amt allowed deducted from SS?
I would talk to your bank to find out if there anyway that payment can be set up with no one incurring fees. Why is not mailing a check not enough?
An automatic withdrawal does not give then access to your acct. Its a once a month thing if thats how its set up. This does not give them access to the account. We have it done with one of our insurance companies.
This morning my husband received 2 texts from the administrator.
1. They ran out of pain pills again and they will split them for the weekend.
2. "I sent out a letter a month ago with the ACH authorization form to be completed and returned or have to pay $50 processing fee starting in Aug. Were you going to return the form?"
I have left messages daily for omnsbudman. They have not called back. This does not seem right.
Thank you, Retired50. Two weeks ago, I had a disagreement with the administrator and had chest pains and went to emergency. I have an $1159 co-pay for what the doctor said was anxiety and panic attack. I am now on a 30 day event monitor and I dread to think how much this will cost.
It is not just paying her items, it is also co-pay on our health issues. Both my husband and I have been to emergency and have a $8300 deductible. It is tight.
How long does it take for the omnsbudsman to call you back?
My husband and I went out of town Friday evening. We were to come back tomorrow.
The assisted living would not allow the nurse we hired out of pocket to administer insulin shots twice a day to perform the duties. Administrator said liability concerns. We had to come back early. We found mother in law covered in urine, her walker on the other side of the room, and her help string out of her reach. No depend on.
Her chair is destroyed from the urine. The smell will not come out.
How sad she is not being taken care of. It really pulls on the heart strings doesn’t it. I would move her to a different facility. I hope you took pictures and file a complaint with the state. Find a facility that has Transportation or hire a ride for appointments. Get rid of the car.
I would check as others have advised you, but do know that ALF often are regulated much less and much differently than nursing homes. They are often considered a sort of rental with services and your choice to be there or not. I sure wish you luck. Many also don't take Medicaid patients, and they don't have to. They can make that choice and often would rather those on medicaid move on. And of course they are actually not "taking control of bank account" but are asking you to let them withdraw the monthly fees automatically, which is easier and less time and bookkeeping for them. Most have regulations written as my brother's did that no more than the monthly fee will be withdrawn and if there are any extra costs the resident or the POA will be notified before withdrawal. I found it a convenience for them and for me as my brother's POA. I always got very timely statements.
Thank you for your responses but I am confused. I have the letter in front of me and they are calling it "a $50 check processing fee."
Is the omnsbudsman the facility administrator? We have talked to her when MIL ran out of some medication she should have had left and the staff split pills.
I’d suggest that you contact MILs caseworker to see if under your States LTC Medicaid program participating facilities are allowed to charge a service fee or processing charge if the elder does NOT make the facility their representative payee for SS &/or other retirement income. And you want the details on this send to you in writing, like either snail mail or via email. Asap. As far as I’m aware, the facilities cannot require representative payee.
Not all retirements allow for rep payee to happen. SSA does but some pensions will not ever allow this. Also should MIL need to move to a NH as she needs a higher level of care than this AL can ever do, having to get a representative payee rescinded may NOT at all be simple or easy. Y’all will be totally dependent on the old facility to do their paperwork in efficient short order, repay any overage asap and good luck on that. This alone is a reason as to why NOT to do rep payee ever. Also keep in mind, that SSA does NOT, again does NOT recognize POA…. so neither you or hubs can go over to SSA to do changes….Hellonwheels would need to herself to do changes and that as time goes by may be quite difficult. Another reason as to why not to do rep payee ever.
Would the AL be ok if there was to be direct deposit for $1368 paid on the 4th of ea month? And y’all do an at the AL personal needs trust account for $200 initially for her spending allowance $? So if she needs $, she has to go down to billing office and sign out for smallish cash.
btw the personal needs trust fund at a NH has federal requirements….. like have to do a statement every 90 days and pay interest. So every 90 days you will know in writing what her balance is and if more $ needed. Keep in mind, If it exceeds $2000, a facility can do a maximum spend of 2K to draw it down to keep them LTC Medicaid compliant too. 2K is the asset max allowed for individual LTC Medicaid eligibility. They will buy an expensive piece of DME (durable medical equipment) like a fancy wheelchair to do a quick, easy and delivered to the facility spend.
Is this AL new to the LTC Medicaid AL waiver program? How waivers run is somewhat different than LTC Medicaid for a NH. Waivers are not dedicated funding like NH $ is, so perhaps this AL more worried abt getting paid as waiver program can stop cold or change rules after a few years. Does staff seem clueless as to how Medicaid runs? If they “helped” do the application & it was 100% done at the AL & they did not clearly mention how required copay limits $ to $60 a mo nor mentioned estate recovery aspects on Mil assets (car), they may not at all understand LTC Medicaid. Or do they seem nervous that as MIL seems to be running up debt that Medicaid will never pay (snacks, toiletries), that her family will be similar?
That she is on a AL waiver for LTC Medicaid is somewhat unusual. Most States do NOT do waivers for AL at all.
MIL on LTC Medicaid waiver & it’s paying for AL, amirite? & I’m guessing this is all brand new for you two & MIL.
If so, imo both you/hubs & AL need to take a step back as there are errors happening on both sides….. - AL cannot force MIL to make them representative payee for her SS. AL cannot force a $50 copay. But can require her account to end ea mo at zero & if need be can require financial responsibility contract done btw POA & them in order for her to stay there. Right now she’s owing $ not covered by Medicaid & makes AL concerned. That’s what the $50 is for, unusual but not unexpected. - AL needs to have an explicit & clear fee structure. If MIL not competent to understand, they need to review with hubs & you. - Why is MIL continuing a supplemental insurance policy? If she’s on custodial care Medicaid (aka LTC Medicaid) then Medicaid can & should become 2ndary health insurance. She needs to cancel or suspend old policy. If it’s an option to suspend it, try to have it suspended. Otherwise cancel. Adios that $98 a mo. - RX copays shouldn’t be happening as should be on whatever pharmacy system Medicaid uses. If it’s that an RX is not on Medicaid formulary, it needs to be switched over to one that is. If her doc writing script isn’t familiar with Medicaid in facilities, it may be the time to have her switch docs. If the AL has an affiliated MD or clinic that most residents use, that’s where I’d switch my LO too. - cell phone / landline. Well if need she can do without unless she absolutely needs 1 & can totally on her own be making all calls. AL should have a landline that residents can use…. Now it may be a phone set up in a seating adjacent to biz office. Personally at $35 a mo, I’d pay that for her but tell her it’s going to be phased out eventually. At some point, Mil is gonna be calling y’all dzs & dzs of times a day, starting early AM & that phone is adios… - the “car” & $800 yr ins + gas & maintenance. So 1K a yr. Here’s the rub on LTC Medicaid & their continuing to own car or home….. they r allowed to have home / car as exempt asset for lifetime & eligible for LTC Medicaid as long as they are otherwise “at need” financially & medically. Financially means IMPOVERISHED. & means they do a copay of all income less that $60 personal needs allowance (a PNA). So if elder wants to keep old house & car they can BUT have no-nada-zero $ to pay a penny on them. So family needs to pay & do whatever to enable their elder to continue to own house / car; it’s totally on family to pay & pay till beyond death. If family cannot afford or doesn’t want to, then either they get sold or go to rot or go up for tax sale. Yeah it’s harsh, but LTC Medicaid means impoverished. She can keep car but on you to pay. IMPT: Please realize that selling her car now will pose issues for her Medicaid eligibility as mo she sells it that $ is income that will take her over Medicaid max that mo & then becomes an asset that if it takes her over 2K in her bank account takes her over Medicaid asset max. She will become Medicaid ineligible. - incidental charges. MIL is doing things that have an a la carte charge. If grabbing snacks, or saying “I want XYZ shampoo”, she will be billed. A resident commissary is not free. Is she competent to understand this? - $50 on site beauty shoppe seems high. I’d ask to see the bill. She could have tipped $$$. - could Mil have given chocolates to staff?
Imo a lot of the issues y’all are having are related to not understanding how narrow LTC Medicaid coverage is, what it’s requirements are and how things need to change once LTC Medicaid done. & this not only for elder but also for POA & family if elder is going to continue to keep old car, old home as family will have to cover costs till beyond death & then deal with estate recovery (MERP) if need be.
If beyond what Medicaid pays, it’s on family to cover those costs. If not done, she’s out of compliance & AL can do a 30 Day Notice to move.
NO! THEY CANNOT!!! AL facilities, nursing homes, rehabs... pull this crap all the time with a POA. They want to make sure it all goes to them even what they are not owed. If you have POA tell whatever AL you're dealing with that you demand a written bill every month. After you get done scrutinizing it to make sure the dollar amount is actually owed, then pay it. They have zero legal right to charge $50 for any "needs" that were not authorized by whoever is the POA (or by the AL resident themeselves if they're still handling their own affairs). Also, when a person is on Medicaid there is no co-pay involved. Whatever AL you're dealing with is trying to shake you down. Don't allow this. Tell them plainly to go pound sand and stop threatening you with this shakedown. Let them know Medicaid doesn't have co-pays. Then insist on a written bill every month. Also, let them know that you will be speaking to the Ombudsman's Office as well as your state's Attorney General. Just for good measure.
Burnt, if Medicaid is paying for her stay, that room&board bill technically is an agreement between the facility and the State. And the “bill” probably will not at all look like a private pay invoice and may be actually for the facility for that month overall. It will not be simple to get the State/NH bill. The resident in my experience isn’t entitled to it.
A LTC Medicaid resident only gets from the NH the monthly statement that is whatever the State Medicaid program has determined is their required copay based on their monthly income (submitted in their Medicaid application) and a separate needs allowance bill. My moms first NH had beyond bad billing office; healthcare side was for the most part at the beginning just fine but administrative a nightmare. Every mo billing errors as they had copay wrong. I did speak with caseworker and he had me contact regional Medicaid office & they sent me their internal room&board payments which shows NH paid in real time and it was like a dzs+ pages; and then Medicaid regional resent the required mo income compliance Notice to both mom, me as POA and to the Administrator of the NH. Couple weeks later it all was corrected and reset to zero after maybe 7 months.
As long as the resident is paying $ amount as per their Medicaid eligibility letter and keeping the on site NH trust account with enough $ to cover incidentals, like beauty or barber shoppe, there should be no charges & no need to have the facility become the representative payee.
Problem is residents go and get things not covered. And in this case, the OP MIL is in AL so it’s an way more active and busy group. Likely most private pay and those residents do not have to ever think twice about buying stuff, ordering extras, going on field trips. But for an elder now finding themselves on Medicaid - so impoverished - they might not be understanding or accepting that they are poor. They cannot blithely just go on the shopping & lunch field trip with others from the AL as they have NO MONEY. Cannot blithely grab a candy bar on their way back from lunch. They can go on field trips, etc BUT need to have their family put extra $ into their PNA or give them $ or a CC so they can pay for things or they do not go on the field trip. If the $50 a mo, the AL is wanting paid is to be used as a payment resource to cover not paid by Medicaid costs, I think this is reasonable and it’s reasonable to have an small administrative fee to do this a well. MILHell & hubs need to review exactly what the charges are and if just going along with the $50 extra is flat the simplest way to deal with his moms spending.
They are right now paying at least $ 4,000 a yr to keep MIL to have her old lifestyle. If this isn’t sustainable from their own wallet, then they imo need to have a come to Jesus talk with MIL to have her realize that she is now poor, things need to change & she has only $60 to freely spend each month.
it isn’t easy and it isn’t at all pretty. But either you get it across to them that things need to change or you as POA / family just pay for whatever charges they rack up or costs on property they own. Sometimes it can make sense for the elder to keep their home and then family pay all costs on the empty home till beyond the grave and deal with whatever after death issues. But if it’s right now a conflict for them, it’s imo not sustainable for years and years.
My husband is power of attorney. My mother in laws social security is direct deposited into her bank account on the 3rd of the month. He writes a check to the facility for $1368 and she gets to keep $60. The facility is stating that if we do not allow them to electronically debit her account, we need to pay them an extra $50 a month.
I do not understand why this happens. It is very frustrating. My husband and I have been fighting over money lately. Since the facility takes all of her check, we need to pay $98 a month for her supplemental insurance, $35 for a cell phone because the facility would charge $50 for a landline, $25 for prescription copays and $391 every 6 months for her car insurance so she can be transported to doctors. I am also spending over $100 a month on clothes because they disappear.
The facility gave me a list of extra charges yesterday $4 for a snack size bag of chips, $60 for a haircut since her beautician cannot go on there premises and $10 for dial body wash because the Dove I bought her disappeared. I took her chocolates Wednesday, yesterday they were gone, the staff was eating them. Her medications are all wrong.
We cannot afford all of this with the increased costs. I may need to get a second job or quit my job to do 24/7 care.
If your loved one is in an Assisted Living facility that is being paid for by Medicaid, then all of your loved one's income--social security, pension- is due to the facility as the resident's "share of cost". They are entitled to keep a small personal needs allowance each month.
Her income is owed to the facility and Medicaid pays the rest. The POA gets to decide whether or not they stay in control of a bank account and then pay the AL bill every month. The reason why they want that electronic deposit is so they can access what they may not be entitled to. They can pad a bill and then say monies are owed whrn they are not. They will also take the small money the resident is allowed to keep every month for personal items. Never allow any care facility access to a bank account.
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State regulations require "X" number of showers per week. (I was surprised to find this out and in Illinois it is 2 showers per week)
If MIL got an extra shower I can understand the fee. And if it took a caregiver (aide) away from doing someone else's shower that could make them out of compliance.
Personally I would be more upset that someone was fired because of the request not the $75.00 fee.
As to the fee that is charged if you write a check. many places will charge fees if you use a credit card and write a check or an e-check". There is more "work" involved. Generally an automatic payment does not garner the "processing fee".
$50.00 seems excessive to me. But both processing fees and convenience fees are legal you might want to check your state and see if there is a maximum amount that can be charged.
It also sounds to me that MIL's needs are not being met and maybe she should not be in AL but rather Skilled Nursing.
I would be concerned with can they deal with problems that might arise after insulin has been given.
I would be looking for a place that can better serve her needs.
They are clueless and incompetent.
To me the overriding issue is that your MILs level of care - insulin by injection, pain medication, transition needed - is beyond what this AL can provide or is willing to provide and what is happening to MIL - RXs not being dispensed as per script, bodily fluids and fecal matter left on skin - is actually causing or will cause serious medical issues to happen. It is not a safe place for MIL.
im kinda wondering if all this obvious incompetence is being done deliberately….. that the AL has found themselves with a resident whose care needs are way way beyond what the staff at a AL can provide. That someone cocked up badly in allowing MIL to reside there. It appears They are doing stuff that makes it difficult to be in compliance for payment so can use that as a pretext to send you all a Notice to Move and then the horrid care situation is going to lead to a care crisis… like wound care needed from the crap show MiL sat in, or some sort of diabetic crisis. Most AL do not ever have the need to have lower rate paid room&board LTC Medicaid beds to run their place; there are plenty of folks who have the private pay funds to pay for AL care; AL don’t need to rely on finding impoverished residents who can be on Medicaid.
The only time I’ve seen an AL ever having LTC Medicaid beds that provided a more skilled level of care was at a facility that was tiered, so went from IL to AL to NH or AL to NH. The AL side had just a few LTC Medicaid beds and they all were basically placeholder beds till someone in a Medicaid bed on the NH side died and then that AL Medicaid resident moved over to the NH. There was continuity of care easily happening as Nh staff could come over and do things. Freestanding AL just are not staffed to be able to provide lots of hands on care; AL “assisting” is more about helping them in daily life activities, like zipping up back of a dress, assisting in transition in the shower, helping them in&out of the shopping trip van. LTC Medicaid pays a fixed low rate, if MiL needs loads of staff time - which it seems she does - she’s a drag on their staffing for other residents. Paying extra for medication management is kinda standard for an AL to charge. But dealing with a resident who need daily insulin and whatever else her diabetes management needs is imho beyond the wheelhouse for AL.
what would be simplest plan would be for there to be something that staff notices that seem to be such that a trip to the ER / ED is warranted and so EMS is called; MiL gets transported over to the ER at a hospital (not a UrgiClinic type of place but ER at a full fledged hospital); ER evaluates her and she gets admitted to the hospital; and then the AL refuses to take her back (they will say “we cannot meet the level of care for her); then the discharge planner at the hospital will then have to find her a place & it will be in a NH as Mil has serious diabetes needs plus whatever else will be in that now nice & fat chart from her ER and hospital stay; that Mil is already on LTC Medicaid will be a big plus for a Nh as they know the $ flow will not be an issue.
TIA aka transient ischemic attack is often used as a reason to call EMS. TIAs are really subjective as to how they present. It’s easy for an elder who is ill or with dementia to look odd enough to have had a TIA. & 99.9% of the time the EMS will load them up and take them to the ER.
ThIs AL is not going to get better and neither is the level of care your MIL needs. Try to get her out, into a hospitalization stay (Medicare pays) and then discharged for rehab (MediCARE pays) at a NH then she stays permanently at the NH (goes back onto LTC Medicaid). Really stay focused to get beyond this clusterF of a AL and get MIL into a Medicaid bed in a NH soon. Good luck.
It was when our mother was admitted to ER and hospital for UTI infection followed by rehab - who confirmed she required much higher care level then provided in AL. The Rehab confirmed there was NO way she could return to her independent AL apartment with no one checking her multiple times per day, giving daily medications and meals, cleaning / dressing and getting her to toilet. No way could AL provide that level of care. Those care level requirements are the differences as to where the elder person needs to reside.
On Thursday, she had an appointment and he asked that she get her shower before the appoimtment rather than after dinner that day. He was told it was not a problem by the aide.
The aide was fired because it was not approved by management and we now have a $75 bill.
My husband is furious. This does not seem right.
I, highly recommend, that your husband contacts the police the next time he finds her soaking wet and untended. This is actually neglect and is elder abuse.
By law the facility has to provide a detailed list of charges. They can't just help themselves to her money or charge extra.
I would tell the stupid sob that is telling you no to a Zelle payment is actually telling you they won't accept a ACH payment. It's a no fee transfer that is the same as an autopay and that's what ACH is, it doesn't give them access to take her money, it's a clearing house.
I think they don't know what they are talking about and from everything you have shared, they are guilty of elder abuse and are now trying to set it up for financial abuse.
Everyone that visits and finds her uncared for and sitting in a dirty diaper needs to contact the police, every single time.
My limited experience with ALF is a resident is evaluated on a care level scale for how independent they can function. I don't know what the policy was for private duty nurses as my mother was transferred to a SNF when her care level needs increased. It was obvious the ALF could not provide that care level. SNF is required to have a nurse staff 24/7 which was not required in the ALF. Basically residents wore an ALERT bracelet and if they triggered it during the night then some night shift person would check in the room and call an ambulance. However, no one checked the residents during the night - they were basically shut in their apartments. The ALERT bracelet is only useful if the patient is actually able to use it during a health crisis.
Also, the administrator has no medical experience and is allowing aides to split pills with no doctor approval.
We know she is not in the correct place and if we give authorization, they have a 90 day policy. Who will pick up the charge when not if she is moved.
This was not the admission policy.
Yes, in some instances there is a charge for doing this by the bank. Seems the AL is being charged by their bank to do this transaction so they are sending that cost onto the resident.
How are you doing this, wiring the money? Are they trying to set up automatic withdrawal? Your LO is on Medicaid and you are trying to set up somekind of withdrawal of their SS check to offset the care.
Is the resident going to live the rest of their life in this facility. If so, why not allow the facility to become ur LOs payee. The only problem would be, if they are willing to set up a personal needs acct for the small amt allowed deducted from SS?
I would talk to your bank to find out if there anyway that payment can be set up with no one incurring fees. Why is not mailing a check not enough?
An automatic withdrawal does not give then access to your acct. Its a once a month thing if thats how its set up. This does not give them access to the account. We have it done with one of our insurance companies.
Please help!
1. They ran out of pain pills again and they will split them for the weekend.
2. "I sent out a letter a month ago with the ACH authorization form to be completed and returned or have to pay $50 processing fee starting in Aug. Were you going to return the form?"
I have left messages daily for omnsbudman. They have not called back. This does not seem right.
It is not just paying her items, it is also co-pay on our health issues. Both my husband and I have been to emergency and have a $8300 deductible. It is tight.
My husband and I went out of town Friday evening. We were to come back tomorrow.
The assisted living would not allow the nurse we hired out of pocket to administer insulin shots twice a day to perform the duties. Administrator said liability concerns. We had to come back early. We found mother in law covered in urine, her walker on the other side of the room, and her help string out of her reach. No depend on.
Her chair is destroyed from the urine. The smell will not come out.
In my state, there is an 800# you can call to find out who the ombudsman is.
You need to complain about the check processing fee, the missing items and the medication mis-management.
Information about the ombudsman should be posted in the lobby of the facility.
Is the omnsbudsman the facility administrator? We have talked to her when MIL ran out of some medication she should have had left and the staff split pills.
This is all new to us.
Not all retirements allow for rep payee to happen. SSA does but some pensions will not ever allow this. Also should MIL need to move to a NH as she needs a higher level of care than this AL can ever do, having to get a representative payee rescinded may NOT at all be simple or easy. Y’all will be totally dependent on the old facility to do their paperwork in efficient short order, repay any overage asap and good luck on that. This alone is a reason as to why NOT to do rep payee ever. Also keep in mind, that SSA does NOT, again does NOT recognize POA…. so neither you or hubs can go over to SSA to do changes….Hellonwheels would need to herself to do changes and that as time goes by may be quite difficult. Another reason as to why not to do rep payee ever.
Would the AL be ok if there was to be direct deposit for $1368 paid on the 4th of ea month? And y’all do an at the AL personal needs trust account for $200 initially for her spending allowance $? So if she needs $, she has to go down to billing office and sign out for smallish cash.
btw the personal needs trust fund at a NH has federal requirements….. like have to do a statement every 90 days and pay interest. So every 90 days you will know in writing what her balance is and if more $ needed. Keep in mind, If it exceeds $2000, a facility can do a maximum spend of 2K to draw it down to keep them LTC Medicaid compliant too. 2K is the asset max allowed for individual LTC Medicaid eligibility. They will buy an expensive piece of DME (durable medical equipment) like a fancy wheelchair to do a quick, easy and delivered to the facility spend.
Is this AL new to the LTC Medicaid AL waiver program? How waivers run is somewhat different than LTC Medicaid for a NH. Waivers are not dedicated funding like NH $ is, so perhaps this AL more worried abt getting paid as waiver program can stop cold or change rules after a few years. Does staff seem clueless as to how Medicaid runs? If they “helped” do the application & it was 100% done at the AL & they did not clearly mention how required copay limits $ to $60 a mo nor mentioned estate recovery aspects on Mil assets (car), they may not at all understand LTC Medicaid. Or do they seem nervous that as MIL seems to be running up debt that Medicaid will never pay (snacks, toiletries), that her family will be similar?
That she is on a AL waiver for LTC Medicaid is somewhat unusual. Most States do NOT do waivers for AL at all.
&
I’m guessing this is all brand new for you two & MIL.
If so, imo both you/hubs & AL need to take a step back as there are errors happening on both sides…..
- AL cannot force MIL to make them representative payee for her SS.
AL cannot force a $50 copay. But can require her account to end ea mo at zero & if need be can require financial responsibility contract done btw POA & them in order for her to stay there. Right now she’s owing $ not covered by Medicaid & makes AL concerned. That’s what the $50 is for, unusual but not unexpected.
- AL needs to have an explicit & clear fee structure. If MIL not competent to understand, they need to review with hubs & you.
- Why is MIL continuing a supplemental insurance policy? If she’s on custodial care Medicaid (aka LTC Medicaid) then Medicaid can & should become 2ndary health insurance. She needs to cancel or suspend old policy. If it’s an option to suspend it, try to have it suspended. Otherwise cancel. Adios that $98 a mo.
- RX copays shouldn’t be happening as should be on whatever pharmacy system Medicaid uses. If it’s that an RX is not on Medicaid formulary, it needs to be switched over to one that is. If her doc writing script isn’t familiar with Medicaid in facilities, it may be the time to have her switch docs. If the AL has an affiliated MD or clinic that most residents use, that’s where I’d switch my LO too.
- cell phone / landline. Well if need she can do without unless she absolutely needs 1 & can totally on her own be making all calls. AL should have a landline that residents can use…. Now it may be a phone set up in a seating adjacent to biz office. Personally at $35 a mo, I’d pay that for her but tell her it’s going to be phased out eventually. At some point, Mil is gonna be calling y’all dzs & dzs of times a day, starting early AM & that phone is adios…
- the “car” & $800 yr ins + gas & maintenance. So 1K a yr.
Here’s the rub on LTC Medicaid & their continuing to own car or home….. they r allowed to have home / car as exempt asset for lifetime & eligible for LTC Medicaid as long as they are otherwise “at need” financially & medically. Financially means IMPOVERISHED. & means they do a copay of all income less that $60 personal needs allowance (a PNA). So if elder wants to keep old house & car they can BUT have no-nada-zero $ to pay a penny on them. So family needs to pay & do whatever to enable their elder to continue to own house / car; it’s totally on family to pay & pay till beyond death. If family cannot afford or doesn’t want to, then either they get sold or go to rot or go up for tax sale. Yeah it’s harsh, but LTC Medicaid means impoverished. She can keep car but on you to pay.
IMPT: Please realize that selling her car now will pose issues for her Medicaid eligibility as mo she sells it that $ is income that will take her over Medicaid max that mo & then becomes an asset that if it takes her over 2K in her bank account takes her over Medicaid asset max. She will become Medicaid ineligible.
- incidental charges. MIL is doing things that have an a la carte charge. If grabbing snacks, or saying “I want XYZ shampoo”, she will be billed. A resident commissary is not free. Is she competent to understand this?
- $50 on site beauty shoppe seems high. I’d ask to see the bill. She could have tipped $$$.
- could Mil have given chocolates to staff?
Imo a lot of the issues y’all are having are related to not understanding how narrow LTC Medicaid coverage is, what it’s requirements are and how things need to change once LTC Medicaid done. & this not only for elder but also for POA & family if elder is going to continue to keep old car, old home as family will have to cover costs till beyond death & then deal with estate recovery (MERP) if need be.
If beyond what Medicaid pays, it’s on family to cover those costs. If not done, she’s out of compliance & AL can do a 30 Day Notice to move.
If you have POA tell whatever AL you're dealing with that you demand a written bill every month. After you get done scrutinizing it to make sure the dollar amount is actually owed, then pay it.
They have zero legal right to charge $50 for any "needs" that were not authorized by whoever is the POA (or by the AL resident themeselves if they're still handling their own affairs).
Also, when a person is on Medicaid there is no co-pay involved.
Whatever AL you're dealing with is trying to shake you down.
Don't allow this. Tell them plainly to go pound sand and stop threatening you with this shakedown. Let them know Medicaid doesn't have co-pays. Then insist on a written bill every month. Also, let them know that you will be speaking to the Ombudsman's Office as well as your state's Attorney General. Just for good measure.
A LTC Medicaid resident only gets from the NH the monthly statement that is whatever the State Medicaid program has determined is their required copay based on their monthly income (submitted in their Medicaid application) and a separate needs allowance bill. My moms first NH had beyond bad billing office; healthcare side was for the most part at the beginning just fine but administrative a nightmare. Every mo billing errors as they had copay wrong. I did speak with caseworker and he had me contact regional Medicaid office & they sent me their internal room&board payments which shows NH paid in real time and it was like a dzs+ pages; and then Medicaid regional resent the required mo income compliance Notice to both mom, me as POA and to the Administrator of the NH. Couple weeks later it all was corrected and reset to zero after maybe 7 months.
As long as the resident is paying $ amount as per their Medicaid eligibility letter and keeping the on site NH trust account with enough $ to cover incidentals, like beauty or barber shoppe, there should be no charges & no need to have the facility become the representative payee.
Problem is residents go and get things not covered. And in this case, the OP MIL is in AL so it’s an way more active and busy group. Likely most private pay and those residents do not have to ever think twice about buying stuff, ordering extras, going on field trips. But for an elder now finding themselves on Medicaid - so impoverished - they might not be understanding or accepting that they are poor. They cannot blithely just go on the shopping & lunch field trip with others from the AL as they have NO MONEY. Cannot blithely grab a candy bar on their way back from lunch. They can go on field trips, etc BUT need to have their family put extra $ into their PNA or give them $ or a CC so they can pay for things or they do not go on the field trip.
If the $50 a mo, the AL is wanting paid is to be used as a payment resource to cover not paid by Medicaid costs, I think this is reasonable and it’s reasonable to have an small administrative fee to do this a well. MILHell & hubs need to review exactly what the charges are and if just going along with the $50 extra is flat the simplest way to deal with his moms spending.
They are right now paying at least $ 4,000 a yr to keep MIL to have her old lifestyle. If this isn’t sustainable from their own wallet, then they imo need to have a come to Jesus talk with MIL to have her realize that she is now poor, things need to change & she has only $60 to freely spend each month.
it isn’t easy and it isn’t at all pretty. But either you get it across to them that things need to change or you as POA / family just pay for whatever charges they rack up or costs on property they own. Sometimes it can make sense for the elder to keep their home and then family pay all costs on the empty home till beyond the grave and deal with whatever after death issues. But if it’s right now a conflict for them, it’s imo not sustainable for years and years.
I do not understand why this happens. It is very frustrating. My husband and I have been fighting over money lately. Since the facility takes all of her check, we need to pay $98 a month for her supplemental insurance, $35 for a cell phone because the facility would charge $50 for a landline, $25 for prescription copays and $391 every 6 months for her car insurance so she can be transported to doctors. I am also spending over $100 a month on clothes because they disappear.
The facility gave me a list of extra charges yesterday $4 for a snack size bag of chips, $60 for a haircut since her beautician cannot go on there premises and $10 for dial body wash because the Dove I bought her disappeared. I took her chocolates Wednesday, yesterday they were gone, the staff was eating them. Her medications are all wrong.
We cannot afford all of this with the increased costs. I may need to get a second job or quit my job to do 24/7 care.
That AL is making bank
Are you power of attorney for the resident?
The POA gets to decide whether or not they stay in control of a bank account and then pay the AL bill every month.
The reason why they want that electronic deposit is so they can access what they may not be entitled to. They can pad a bill and then say monies are owed whrn they are not.
They will also take the small money the resident is allowed to keep every month for personal items.
Never allow any care facility access to a bank account.
Can you clarify what your question is?
They are charging you 50.00 for your loved ones Medicaid copay?