Help- Medicare and nursing home

[kellia]

I am looking for some advice for someone's 90 year old "Grandma". Her son was living with her taking care of her until he died suddenly 2 years ago, now she just has 3 grandkids taking care of her. She was fine on her own for a few months, but then fell and was in hospital/nursing home for rehab for about 3 months. One grandchild had arranged for her to go to a nursing home after she got out and was told Medicare and her Blue Cross would cover it. But, another grandkid took her home and arranged for a few friends of a friend type persons to live with her and paid low wage under the table.

The 3 grandkids have been rotating and staying with her on weekends. Once the grandchild realized that this was going to last a lot longer than he'd thought, he tried to see if they could put her in a nursing home but was told since he'd taken her out of the hospital and said she'd have someone at home, her insurance wouldn't pay for it. This has been going on 1.5 years. The current caregiver just quit and they can't find another one for the pay grandma can afford. Her savings is gone. Her house isn't worth much right now and would need a lot of fixing up before it would sell, so they can't just sell it quickly and use that money.

Grandma's dementia is getting worse. She can barely get around with a walker and needs assistance in the bathroom. There is no way she could cook for herself or take her pills correctly. The 3 grandkids don't live nearby and since they are in their 30's are working and have kids. They have no idea what to do now. Is her doctor right that they can't get her insurance to pay for her to be in a nursing home or any kind of home care? Do they really just have to leave her along until she hurts herself before they can get help? I'm hoping that someone here will have some kind of advice to give because they have no idea how to handle this or who they should be going to.

Thank you!

 

[LauraLea]

Have them contact an attorney specializing in Medicaid planning. Unless she qualifies for skilled nursing care, Medicare and insurance will not pay for any type of assisted living.

Dementia does not qualify for skilled nursing (nursing home) care in most states. All states are different when it comes to getting assistance.

This spring we had to put my mom in a Memory Care unit of an assisted living facility. She had been living with us for the last 3.5 years. The attorney helped us tremendously. We were not aware of the assistance she could get since my dad had been in the military during war time.

Like I said Medicare and Medicaid are applied differently by the states, so you really need to get an expert to guide you through all the requirements.

Laura

 

[Maddle]

Unfortunately, yes - the grandmother must have a minimum inpatient hospital stay (I believe 3 days) before medicare will pay for a Skilled Nursing Facility (SNF.) Even then, it is not a permanent solution...medicare will only pay for your "recovery" time.

Grandchildren can start with Grandmother's doctor's office staff. Have them refer Grandchildren to the social services/elder care options in the county. Look for county/city senior centers that may have social workers on staff.

An attorney specialist as the PP suggested can be very helpful, particularly if there are assets...but the social worker may be aware of the aid for which Grandmother is eligible and get her case started. A home visit may be required to fully assess Grandmother's needs.

Best wishes to the Grandchildren. Medicare/Medicaid is a rat's nest of arcane rules and regulations. It's a steep learning curve for every family - and by the time you learn the ropes, you don't need the knowledge anymore. Know that God will bless them for the loving care they provide for Grandmother...she needs them now more than ever.

Maddle
(Who's right there with you!)

 

[Nancy F]

We had to get welfare for my uncle to help pay for his nursing home care here in NJ. His pension and Medicare weren't nearly enough to pay for it. Thank God the two were just under the limit of income for him to qualify for welfare. We had to pre-pay his funeral to get his life insurance taken out of his income to make this happen.
Nancy

 

[kellia]

Thank you for the replies! Wow, I always thought Medicare covered all of that, good to know. I had wondered if she'd qualify for Medicaid, her SS + pensions is about half what the monthly rate is for the places they called. I will definately pass all of this along.

 

[whatname]

You could also call the admissions coordinator at the nursing home and explain the situation. They will know the laws in your state and ins and outs of getting care. They can also refer you to an eldercare lawyer, if needed. But, the admissions coordinators deal with the situation regularly and should be able to give some good advice.

 

[jel0511]

And also know not all nursing homes except medicaid. Those that do usually and are REALLY nice have LONG waiting lists to get in. We're dealing with this and haves my FIL in a facility that is ok, not great, but ok, the REALLY nice one down the road had a year waiting list. There are other nicer facilities, but they don't accept medicaid. The rules really do vary state to state and sometimes county to county, it depends where you live. I suggest you contact an attorney or a social worker who can help you through all the red tape.

 

[mw3602]

If she has traditional Medicare then she may qualify for some home health services through her Part B coverage, however she will need a physician's order. If she has a Medicare Advantage plan with with her Insurance Company, I would call to ask them directly about the benefits. For that situation, I would also call a local HH service and ask for some advice.

What state does she live in? Medicaid is definitely an option but the laws vary state to state.

In order to utilize her Medicare A benefits at a Nursing Home she needs to have a qualifying hospital stay, which consists of 3 midnights admitted inpatient AND she will need to have orders for skilled services. The catch with this is that while your entitled up to 100 days of skilled nursing services, you must meet specific guidelines in order to utilize all 100 - not many people use the full amount at one time. So, she could get anywhere from a few weeks to 100 days covered by Medicare. Medicare will cover days 1-20 at 100% then days 21-100 currently have a $148/day copay. If she has supplemental insurance they may pay for all or a portion of that. If you can get her qualified for Medicaid then it won't be a concern.

Dementia alone will not qualify her for Skilled Nursing services, however, that is different than admitting as a long term resident in a Nursing Facility. Where I am we have what's called Council on Aging and they have to approve all admissions to a Nursing Facility - regardless of payer. Basically, they make sure that the person is appropriate for a nursing home or, if not, help find better placement. I would find out who your area Aging office is and I'm sure they can point your in the right direction.

You can PM me if you have some more questions that I can help you with. There is a lot to know and learn - I do this for a living and I've seen the stress this puts on families in your situation.

Sorry - I'm just a daily lurker and never post so I don't think you can PM me yet

 

[McKelly]

The dementia thing is impossible to qualify for long term nursing home care, tried that with my mom for many long months. The grandma would probably qualify for assisted living, but as someone mentioned, the good ones have long waiting lists and most of the them require at least two years private pay before they will accept Medicaid, at least in WI they do.

Your best start is the Council of Aging. I would save yourself some time trying to qualify for anything regarding dementia and focus on the falls and if she is losing weight...that's a biggie too.

 

[tvguy]

And also know not all nursing homes except medicaid. Those that do usually and are REALLY nice have LONG waiting lists to get in. We're dealing with this and haves my FIL in a facility that is ok, not great, but ok, the REALLY nice one down the road had a year waiting list. There are other nicer facilities, but they don't accept medicaid. The rules really do vary state to state and sometimes county to county, it depends where you live. I suggest you contact an attorney or a social worker who can help you through all the red tape.

And most facilities that accept Medicaid, you wouldn't want to put a loved one in.
I was lucky my mom bought long term care insurance years ago. Didn't need it until she was 89, and then only for a year, but it helped a lot.
I think the most startling thing to me is that most people in care facilities pay for the care out of pocket. None of the 4 car facilities I looked at had ever had a resident with long term care insurance. The paperwork required was a little overwhelming, and you have to pay the bill out of pocket and submit a claim, but I got the checks quickly once I got everything set up.

 

[twinsmom]

I work in a nursing home and have for over 12 years. Please call the admissions coordinator of the nursing home you all are interested in placing her and speak to them asap. Sounds like she will qualify for Medicaid which covers nursing home care if a physician certifies she needs the care. The nursing home can accept her pending Medicaid so you don't owe anything and they will accept the Medicaid once she is approved. Here in my state typically there is no need for attorney involvement just get with the nursing home admissions person to get assistance.

 

[twinsmom]

By no means are there waiting lists in all the facilities that accept Medicaid and just because a facility accepts Medicaid does not mean it is not a wonderful facility. I am sure some places have waiting lists but not all. I work for a company that has over 60 homes in various states and waiting lists are not the norm.

 

[trip]

If Grandma's husband was a war time veteran, she may be eligible for a VA program called Aid & Attendance Pension. http://www.veteranaid.org/eligibility.php

If she is eligible, because of her age she should ask that her application be expedited. I understand the process could take a long time.

 

[buzz5985]

If Grandma's husband was a war time veteran, she may be eligible for a VA program called Aid & Attendance Pension. http://www.veteranaid.org/eligibility.php

If she is eligible, because of her age she should ask that her application be expedited. I understand the process could take a long time.

Yes and just because she has assets - doesn't mean she will not qualify. My father qualified for practically the maximum and had a house and money in the bank. He was a Korean War Vet.

Good luck.