Private Board and Care vs. Medicaid covered SNF. Almost out of funds....don’t know what to do. Any ideas?

Please, please, please - you need to think about your own future and retirement. Do not spend YOUR $$ on her care. Sell the condo - use HER money - when it is gone - she can apply for Medicaid. My dad had wonderful care in his Medicaid nursing home.

I would sell her condo and use the money for 4 more years of her care where she is at. That would put her at 99 years of age, and no guarantee really that she would even still be here. If she goes on Medicaid, while owning her condo, after she would die, Medicaid would get her condo anyway, or the proceeds from it after it was sold, to cover any of her care for the last 4 years, or however long she was under Medicaid. So if you're pleased with where she's at now, I would just let her stay where she's at, using the money from the sale of her condo. Best wishes.

Shelly, there will be nice Medicaid accepting facility for her as long as she meets the “at need” requirements for financially “at need” and needing skilled nursing care for medical “at need”. As others have said, you’ve got to do your research. The Board & care home won’t put her in a new place, neither will the State Medicaid program, it will be on you to find a facility that takes Medicaid and on you to provide the documentation need for her LTC Medicaid application both financially and medically (if she’s not moving into a facility as a post hospitalization discharge to rehab in a skilled facility). It may be that you have to go out of your nearby area - perhaps in another county that’s more rural - to find one that seems to work for mom. I think the biggest initial concern for you to overcome is that the ratio of staff to residents is going to be quite different. Board & care homes have to stay small, maybe under 10-20 residents as that’s how they get around having to have the full staff that a NH, AL or MC does. I’d try to look for facilities that are smaller; the # of beds is in the CMS / Centers for MediCARE & Medicaid lists. If your mom is an active type, I’d look for places that have a full time activities director and look online to see photos of just what they do. My mom was big on arts & crafts, her first NH basically did zero, her second did and had a published monthly schedule. Happiness! Info on stuff like this are out there, you just have to research.

But I’m way way more concerned about your - yes your - situation in all this. You posted your & her $ is almost gone. If you have been using your $ to cover your moms Board & care home to the point that is depleting your own future retirement & financial security, please PLEASE just stop. What’s going to happen when you yourself need $4,800 a mo for care? So if you do that, when does mom run out of $?

On the condo, so are you living there? Or do you have your own place? I’m guessing you live in the condo.... so Is it in moms name or hers & yours? If it’s in her name, Medicaid will consider all house sale $ to be 100% hers.
Others have posted suggesting that you sell the condo, if you did that where would you live? & can you afford to buy your own place? Yeah you’re working but if you’ve been working just to pay for moms care, has all this put you without your own emergency fund and savings to have your own place? If selling condo means your without a home, you need to figure out what your future living needs to be and do it soon while you are still working and can get a mortgage if you want to buy.

if condo is only in her name, AND if you’ve been paying all the costs on the condo, it’s going to be way difficult to easily reinburse yourself for her share of property costs paid by you from condo sale $ (if you were anticipating this happening). If you’ve been commingling her $ & yours, I’d really really encourage you to find an elder law atty ASAP to discuss just how to unthread the commingling of assets & expenses that’s happened. Do it before either of you file 2020 taxes too. You need to do this before ever applying for Medicaid. I know it’s really easy just to pay for stuff on their behalf. But if it is her property, even if you live there rent free, part of the property costs are still hers, she should be paying.

Also the B&C shes at has dealt with your situation before. They probably have suggestions on NH or MC places where former residents moved to once they needed a higher level of care. They might can put you in touch with family members who can share thier reviews of the places too.

Sell the condo. My mom had to sell her mobile home to be in AL. It was her egg nest. The condo is your mother’s. And yes Medicaid will take it anyway. Hopefully some funds will be left after she passes..

Why aren’t you researching local nursing homes? You can choose where she goes even if she’s on medi-cal. You just have to find a facility with a medi-cal bed available. Most facilities in the state take Medi-cal. Sell the condo and private pay for a few years. If you private pay using your moms funds, it will be easier to get her in to a nicer facility. Otherwise when the time comes, she’ll go wherever there is a bed available.

Also something else to keep in mind, the “at need” medical requirements for Medicaid placement into a NH are pretty precise. If she’s coming in applying for LTC Medicaid she’s going to have to meet those requirements. If your coming in as private pay, way more latitude in what’s required for entry. I mention this cause I’d be concerned that if your mom has been in her lovely board & care home for a while they might not do regular in detail medical history as not staffed or required to do this. And if her MD finds her to be just fine & dandy and ok to live to 100..... well mom may not - as her health chart in his office looks like right now - again may not, have the details & lab reports in her medical history to clearly show she needs the Medicaid required level of skilled care in a facility. Just being old, having some dementia, cannot do thier “medication management” or require help in ADLs, may not be enough to show the need for skilled nursing care aka a NH, if your hoping to place her in a NH that takes LTC Medicaid or at risk enough to place her in a MC facility that takes LTC Medicaid.

You may want to get a needs assessment done to see just where she stands in being “at need” for NH or MC. If she’s good for AL, most states medicaid programs do NOT pay for AL. You’ll need to clearly find out just what CA Medicaid does.

As an aside on this, the majority of admissions to LTC care in a NH tend to run this scenario:
- mom / dad living at home on their own & all just fine;
- have a bad fall & break a hip;
- go to the ER (mediCARE pays) and then get admitted to hospital & hip surgery scheduled (mediCARE pays);
- get a post hospitalization discharge for rehab at a NH that has a rehab unit (mediCARE). MediCARE pays for their stay in rehab at 100% first 20/21 days & get determined before Day 21 that they are not able to return home.
- They then segueway from being a MediCARE patient to becoming a LTC resident. MediCARE doesn’t pay for LTC residential care, that’s either private pay, LTC insurance or they apply to LTC Medicaid. For this scenario, they have a nice fat detailed medical history that show them to be “at need” medically for Medicaid to pay for their stay. They then just have to qualify to be financially “at need” for Medicaid.

Often if they are coming from living at home, in IL, AL or board & care place, that fat medical history just may not be there. They get declined for being “at need” for Medicaid, even if they are eligible “at need” financially for Medicaid. I’d suggest that you have a clear discussion with her B&C & her MD as to if she is “at need” in her charts and get a needs assessment done to help establish that this exists.

yes I know it’s a lot of moving pieces, and it’s why folks get an Medicaid savvy elder law atty to help do the application and deal with all aspects to be “at need”. Good luck.