My mother in law seems decently happy in her home. Recently, there were some billing problems between us and the business office. We noticed her automatic payments hadn't been made and continually reached out to have these fixed (September of 2021). We were told at the facility that they outsource their billing and the billing office is located in another state. But we emailed and called for ages without reply. In December, I received a letter from Social Security that said her deposit account had been changed. They said they would look into it and call me back after the holidays. I then noticed her direct express card, which had been acruing all her benefits since the autopay for the nursing home wasn't working, suddenly dropped all the way down to zero. I received a phone call at the end of January that the entire business management department had been audited, laid off and a new department had been hired. Then I received a phone call in February from a seemingly nice young lady who told me she had inherited this giant mess and wanted to work with me to get everything straightened. She said that the business office had requested her payment information be changed due to non-payment and that I should just call SS and request it change back. She sent me a statement of the bank account where MILs social security was going and everything looked good. The only charges were for the nursing home costs. We went through every payment, and every charge, and settled up at the beginning of March (March 7) and she said everything was up to date and left a $0 balance due.
Then I noticed that the April payment didn't pay from my MIL's alimony account, but her statement showed a double charge for March 7 so I figured she'd accidentally been charged twice and didn't worry. I got an email at the beginning of this week that MIL's payments were behind again but by way more than just two months charges. I requested the statement from her SS account again, as that hadnt been fixed yet but was met resistance. When I finally got that statement, there were several charges for her care costs that weren't recorded, but also several charges for something labeled "Resident Cash Advance" that are labeled as transfers to "petty cash". The nursing home says it's for things that MIL wanted to buy from their duty store, so they just let her buy the things.
My question after all that is, can the nursing home do this without consulting me or providing a reciept for what was purchased? I have sent an email to her Medicaid/Medicare case worker asking about switching her homes. SS has already said they have stopped her payments and will be putting them back on Direct Express in my name again. They seemed genuinely confused about the whole thing because the notes in their system say I personally called to change that deposit info. When I told her I don't have access or control of that account at all, she was very upset and said she would stop payments immediately and escalate me to tier 1.
Is this a normal thing for nursing homes to do or ? How do I resolve this?
If she has a debit card/check book, take it away. What I have done for my mother is given her a small amount of cash for her to keep for purchases within the home or when she is out and about without me. I have ALL other financial instruments. As far as anything else, the nursing home puts the charges on her bill. These are things such as self-pay therapy, hair cut, personal care items, meals with my sister that they provide, etc.
The two homes she has lived in do not have ACH payments, so I would ask if they have to be automatic payments so that you can receive a bill and pay it when you get it. I have rarely found anything required to be automatic payments except websites, such as Amazon Prime, or other subscription type services. If automatic payments are required, I would get a checking/debit account that contains ONLY the amount of her monthly nursing home charges. It's extra work for you, but then you can take the money off her Direct Express card and put it into that account each month. However, I doubt I would keep her at that facility and would report them to Social Security and the state for fraud. I did find out that ALL nursing homes accept Medicaid, they just don't advertise it. You can go to Medicare.gov to find out the ratings of homes in her area and then contact only the ones that have 5 stars to verify they have a Medicaid bed available for her or if they have a waitlist.
Finally, I would suggest contacting an elder care attorney in your area to have in your back pocket if you don't already have one. My mom's has been a huge help many times since we first used him to draw up the Power of Attorney documents. I hope this all helps.
If the care is good I would not move her. Good facilities are hard to find. What a mess the billing turned out to be and no wonder they changed the billing process. At least they have done what they can to fix it. Changes like this are never easy or seamless and are very difficult to resolve.
Always avoid knee jerk reactions in everything. Think things through.
In addition to an elder law attorney, I would contact the state office that regulates nursing homes. If she is on Medicaid, then your state also oversees nursing home expenses (to be sure Medicaid funds are being used correctly.) You could raise your concerns about the very mixed up billing, the inconsistent responses, the fact that you got it all sorted out once and it immediately was messed up again. You don't have proof of fraud, but you have good reasons to suspect it.