My mom is 92, currently in rehab at NH after an initial fall & then found she needed a pacemaker. She had a rough 12 days in hospital with lack of sleep & "sundowning" complete with hallucinations. She's been in rehab 25 days & she's doing very well with the physical therapy part but needs cues & help with daily living skills. She definitely is showing the dementia, often thinks she's at home & asks us to get things in kitchen,etc. We know she needs to be in long term but can only afford with Medicaid. I just turned in application 2 days ago, afraid they will want to discharge. She qualifies financially with SS of $1538. She owns a home, assessed at $184,000 but has had a reverse mortgage with line of credit & has used $131,000. I don't know how that will affect the Medicaid. I've looked at her files from NH as we were on our way to doctors. 2nd thing listed is Alzheimers/dementia so is this enough to keep her and move her to long-term? Thank you.
Yes, the cardiologist is aware of dementia. She has an appt with him on Thurs, hoping he can make recommendation. Last visit, I was told it would be dangerous for her to be home on blood thinner, although I realize she could fall in NH. The nurse practitioner said we as a family should decide blood thinner risks of falling & bleeding vs. no blood thinner & risk of stroke. That's not much of a choice.
Are you planning for her to get a pacemaker?
I'd make it clear that you are not able to take her from the facility and provide her care. They'll need to figure out what level of care she needs, which facility would be best and how she'll pay for it, based on her ability.
Still, I don't see how they can insist you provide her care. It's based on her ability to pay and something will have to be done, based on her need and ability to pay.
And if you are her Healthcare POA, do you have the option of finding a Geriatric Primary? They are more experienced in treating seniors and those with dementia. Did the doctors who suggested the pace maker know she had dementia?
I'm in a different state where person permanently leaving their reverse-mortgaged home means that the bank requires the home to be sold. Any proceeds would then be available for NH care. That may "sweeten the pot" for the NH. But maybe MD is different. Just thought I would mention it.
If she was in rehab post hospitalization then she probably has the hefty medical chart that shows need, so orders can be written by the medical director of the NH where the rehab unit is. If not, then she may need tests done or other evaluations done to get the orders and the medical chart to show need. Like for me, my mom was in IL and did the hyperspace move from IL to a NH avoiding AL or a hospitalization/rehab situation, for mom it was more of a chart building process that took about 5 months. If yours is in rehab and not progressing, she can get orders done pretty easily I would think.
The meeting next week on 7/3, is that a care plan meeting? if so you may want to write down any ?'s or concerns you have so you can bring them up at the meeting. You may want to have someone go with you to take notes. Once they are in a NH, the care plan meetings are every 3 months. They are really good as usually there is someone from each area there (nursing, dietary, activities, social work) but usually neither the MD/medical director nor the DON (director of nursing, she is the goddess & ruler at the NH btw) come to the meetings. So if your wondering what arts & crafts could happen, or outings, or what the medication schedule is, or how she deals with cardiology issues, this is the time to ask and get group input. The plan is written down and you will be asked to sign. SO if there's something you want done, you put it in in the tiny space above your signature. My concerns with my mom were dietary issues and they did get on it and change what her meals were like.
Good luck in all this. It sounds like you've got her in a well managed place. Try to develop good relationships with the staff and it will downstream into good will for them in dealing with your mom.
With a reverse mortgage, however, you receive a check each month from the bank or mortgage company, and you never have to pay them back as long as you live in the house. If the loan is made to a married couple, then no repayment need be made until neither spouse is living in the home.
At that time, the loan is repaid, plus interest. If the family members cannot pay the loan off, the house will be sold. Note, however, that if the amount of the loan exceeds the net proceeds from the sale of the house, the bank is simply out of luck—it cannot come after the family members for the shortfall.
Thus, a reverse mortgage may make sense for you if:
You find yourself short of cash each month;
You would like to make lifetime gifts to your children or grandchildren and don't have the cash to do so;
You would like to have medical treatment not covered by Medicare or your health plan;
You would love to go on an extended vacation;
Your spouse must move into assisted living; or
You like the idea of drawing down some of the equity in your house without having to repay the loan during your lifetime, so long as you are living in your house.
The amount you can borrow depends on your age, the value of your house, and the current interest rate. The older you are, the more you can borrow, since your life expectancy is shorter and the bank won't have to wait as long to get repaid. Also, as interest rates rise, the amount you can borrow decreases.
However, it rarely makes sense for a single person who may soon need nursing home care to obtain a reverse mortgage, because as soon as they move out of the house, the loan will have to be repaid. That will cause the house to be sold, exposing the cash that had been protected by the home exemption. Then you have to figure out what to do with that cash so that the person qualifies for Medicaid!
A reminder: everyone, don't engage with people who argue. They don't need encouraging! Smile.
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