Quick question, what to do when someone is requested to leave AL?

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Quick question, what to do when someone is requested to leave AL?

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As the per topic, what are my options when someone is said they have to leave AL due to requiring too much care, but you are unable to afford MC and no Medicaid bed is available in the same facility.
The price jump is far outside my budget, my parent has no assists and in our state (NJ) for the most part it seems every MC has a two year period of private pay before they can even be placed on the Medicaid list. Can they kick my parent to the curb if I am unable to afford new placement, are they responsible to find suitable placement? Their case manger told me it was my responsibly to find placement they can afford.

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I live in South Jersey. In my area there is no such thing as board and care. ALs and MCs are private pay. And yes, Medicaid may pay if you have private paid for at least two years. But, the AL and MC may only take a % of Medicaid recipients. If they have met their quota then the person will not be able to stay.

Your parent maybe ready for Long-term care. If she has no assets, you can file for Medicaid LTC. They will pay for ur parent's care with their SS and any pension going towards their care. A Medicaid caseworker can help with this and it is your responsibilty to find a place. If ur parent is ready for MC they are ready for a NH. I feel my Mom was better cared for in the NH. MC is only a step up from an AL. Its more of a lockdown facilities. The care not much different than an AL in my opinion.

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My mother's MC cared for her far better than the SNF she was in for seven months before. They handled all her medical issues just fine, but the focus was on mental stimulation and socialization like an AL would do. She had dementia, incontinence, was wheelchair-bound

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One of the major differences between MC and SNFs in NJ is that SNFs can provide skilled nursing services (IV, TPN, wound vac care) as well as custodial care. This is because they are required by law to have RN's on site 24/7. ALs and MCs are only required to have access to an RN (they don't have to be on site) so obviously no skilled nursing as in NJ those services can't be provided by CNAs. Just got the confirmation of the above from a seminar hosted by the NJ Ombudsman's Office and thought I would post here for the NJ folks who might be interested.

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SNFs are regulated by the federal government, so that part is the same in every state.
Some states allow 'board and care' homes or 'rest homes' - custodial care in a home like setting. Can be a good choice.

Assisted living and memory care units are classified in most states as a person's residence.
The idea is that when you sign a contract before you move in, you are agreeing to a lease on an apartment (as in any apartment lease) and ALSO a contract for services. AL has several layers of services (with increasing prices) and memory care is more expensive.
When a person is unable to meet the requirements of being a tenant, they are asked to leave. First step to being evicted, like any tenant who refuses to pay rent. When a person needs more care than the facility can provide, then the person is violating the service contract. And that is also a condition of occupancy. So, you can be asked to leave for either reason.
If indigent - $2000 in savings and low monthly income and no liquid assets, then Medicaid can help with medical care costs.
A person must also meet the clinical criteria for SNF in order for Medicaid to pay.
A certified geriatric care manager is the person who can give you the best guidance. Usually these are RNS or master's level social workers who have additional training and experience in geriatric care management. It covers a lot more than just finding a place to live. Call your local elder services agency and see if they have a list of local resources.

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In general in these cases the patient enters into care in a Board and Care that can accept his or her level of care, or a Nursing Home. Whatever assets the patient has go to this care. When these assets are gone the patient is eligible for Nursing Home that accepts medicaid, and medicaid is applied for and hopefully approved. Most MC facilities don't accept medicaid. If you are the POA for the patient then you will be responsible for finding placement. If the patient has no POA it is not necessary for you to become such nor to become a guardian or conservator. In that case the ALF Social Services will contact the State and the state will appoint a fiduciary to act as conservator. However, at that point you will have no say whatsoever about where placement is, how near or far from you, nor what assets are sold for care, and etc.

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My parent already is on Medicaid, and I do have POA. That means the case manger was correct it is my responsibility to find them suitable placement. Generally does it work like other forms of eviction so to speak I have 30 days to find new placement?
What happens if I am unable to find a placement? Their case manger is not being very helpful.

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I was in the same position in 2015 when my father became too much for the AL to handle; he became a 2 person assist and it was in the contract that the AL would NOT keep my folks if that was the situation, and both of them lived together in the same apartment. I was faced with placing dad in a SNF (private pay) and keeping mom in the AL, separating them, after 68 years of marriage (!) and watching them go broke in short order paying TWO astronomical bills each month. I was freaking out. Dad was acting 'off' too, in that he was slumping over to the side in his wheelchair and I was wondering WHY he suddenly became a 2 person assist?

So off to the ER I took him, via ambulance, to get some answers. Dad had a brain tumor that had grown and it was killing him, the MRI revealed. The doctor at the ER told me that sad news and that she felt dad had 3 months to live, so it was a good idea to get him a hospice evaluation asap.

I went back to the ALF, got a hold of the Assistant ED, told her what had transpired at the ER and that we needed a hospice evaluation STAT. Hospice came in, evaluated dad, accepted him, and that's when the AL backed OFF and said they'd keep dad until DEATH, in spite of him being a 2 person assist. WITH the added help of hospice, most ALs will agree to KEEP the resident, regardless of how much care they require. Not everyone realizes this.

Is your parent eligible for hospice care at this time? Find out, that is my suggestion, b/c if they are, this may allow the AL to KEEP them until death, even if your parent winds up living for a year or more.

If my dad hadn't qualified for hospice care back then, it would have been MY responsibility to find him alternative placement elsewhere b/c the AL he lived in was private pay. It was not their duty to find him another place to live; it was MINE.

Wishing you the best of luck with all you have on your plate.

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Another question, what exactly is the difference between MC and SNF? I went to visit a few SNF that had rehab for my parent a few years ago after their stroke and they looked more like hospitals then places where someone lives. The level of care did not seem all that much different from what they were getting in AL. They had someone check in on them regularly.
I fail to understand how SNF will be able to meet the increase demand in care they claim, if AL was unable to do so. Seems MC is the proper level of care with dementia.
I do have POA, if I am unable to find suitable placement that is willing to tell her, been making phone calls but it is Sunday and not many places are open. The list of names I was given their ratings and reviews were not very pleasant.
Let us say I have to place them in a less then I ideal place how do I go about trying to maintain the best quality of care while being unable to visit every single day. I still work full time.

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Please hire a social worker to help you with their placement into a new facility. Generally, caring for somebody at home is less expensive in terms of money but more taxing on your energy and time. Check to see with Medicaid about round the clock home health care.

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Agreed that it's 'less expensive' to the system but can take everything the home caregiver has, including not only money to finance the cost of home care but also, future earnings, depending on the caregiver's age. Too many working people in their 40s and 50s, which they'd expected would be their peak earning years, are forced to give up these working years because of the demands of home care. So, regardless of what the patient has in terms of assets, the home caregiver is at risk of not having much in terms of assets for themselves.

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SNFvsMC: You do not foot the bill for your parent's care from your own financials. That is the parent's financial responsibility. You may require the assistance of a social worker and state your concern that your parent has no assets and will have to rely on Medicaid.

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What would they say if your parent had no children? I've heard of people being kicked out, but I can't imagine such a terrible situation. My question, why can't they sedate the patient until he/she is calm and compliant? Perhaps you should request a visit with the elder psychiatrist the facility recommends to get solutions.
You might also bring up this topic with your governor and elected officials.........we all face the possibility of dementia and most do not want to ruin their loved ones' life with mental and physical dependency. When you advocate for one dementia patient, you advocate for all of them. Pretty soon the Baby Boomers will need to live in tents on the public streets to get attention and funding for end-of-life-care: Motel6 for everyone, right?

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Using sedatives until someone is calm or compliant may not be the best suggestion when it comes to advocating for care for those with dementia.

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As I’m understanding it your parent is currently in AL being paid for by Medicaid and this facility also has SNF with Medicare beds but none available. Is this the first it has been mentioned to you that your parent is getting or has gotten to the point that they need more care than AL can provide and will need to move to SN? Was your parent on Medicaid when they moved into AL? Was it discussed at the time they moved in or you chose this facility that one of the advantages was that they both have a SNF and Medicaid beds that your parent could move to should the need arise? Did you ask the case manager where your parent is on the list for a Medicaid bed and why they aren’t closer to the top (if they aren’t), why they didn’t foresee this sooner so there would be a bed? There may be very good reasons for this but you have a right to be clear as to what they are. I would push back a bit making it clear, if it’s the case, that a big reason for choosing their facility was the ability for your parent to stay there on Medicaid should they need skilled nursing, the move from one room to another is a big enough upheaval for anyone in this condition and you believed that the upheaval to them and you of moving to an entirely different facility wasn’t going to be necessary when you chose them.

There may be various things at play here but it might also be as simple as they play the balance between taking in new patients and managing their Medicare beds, it is after all a business, some are greedier than others and telling clients “your loved one needs skilled nursing but we don’t have any Medicaid beds available, you need to find your own” is always the first thing they try to weed out cases. Those that just take it at face value and take it all on themselves, the way you are, find a place for their LO without another word help lessen their case load. If the case manager doesn’t have to do any work they often won’t, doesn’t mean they shouldn’t. Then there is the full pay/Medicaid difference and there are a variety of “full pay” as well. If they have one bed in SN for instance and have the choice between a patient who would be coming in as full pay for 6 or even 3 months before becoming a Medicaid patient…well…on the other hand if they have a current client in your situation who is unhappy about the situation maybe they have to weigh the difference between reputation, how far you might take it and that 3 mos of extra income. I don’t know that this is the case but it wouldn’t surprise me, they are a business under the crunches of businesses rite now, especially healthcare businesses. I’m not suggesting you be difficult, I would try very hard in fact not to be, find that balance between a constant itch and difficult, help any way you can but unless your contract says something different at the very least expecting the case worker to help find an appropriate placement is not unreasonable. Don’t be the bully but don’t let yourself be bullied either. Take a deep breath, don’t panic and good luck!

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Limey61: "Don’t be the bully but don’t let yourself be bullied either." Very nicely put!

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I missed this thread when it was first posted, and OP if you are still here it would be helpful if you have any updates. I would have advised to contact the ombudsman and your state's elder protection services. A state social worker would be able to find a facility and ensure the protection of your parent. Do not under any circumstances agree to take parent home with you.

Quick question, what to do when someone is requested to leave AL?

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