patrick.net

I will be looking to buy that book, Ellie! I will also post it on the AD forum and chat room too.

Just heard today my Mom will be released from the SNF back to her Care Home next week.

My Mom had been living at a Residential Care Home. She is on private pay. She has Alzheimer's Disease and will be 68 this month, and she is latter stage now. I hope she can just stay there because she can afford it.

She seems to bounce between that place, the ER and the SNF for the past 6 months anyways with a UTI and blood infection and a hip fracture...

Look forward to reading the NH book!

Marianne:
I'll let you know about the book (link should be up within the next few days) - Patrick is working on the link. It's an ebook but will be a hardcopy soon too. I'd like to educate as many as people as possible, while making a little money.

Your mom is in the latter stages of Alz Disease, has experienced multiple trips to the ER. Have you considered hospice? This would mean that you would no longer aggressively treat her (oral medications okay, but no more trips to the ER unless it's for a fracture or something unrelated to the Alz Disease). It would save you money on supplies and equipment, as well as giving her a personal attendant to bathe her 3x (or more) each week plus a nurse to oversee her meds. She would also have many medications covered and there's no cost to you for this.

Hospice is different from home health in that your mother would not have rehab services to get her "better." If this is what you want, or you want more info, ask around. I personally prefer hospices that are smaller but have been in business for awhile. If you speak with a company that does both home health & hospice and has done it for awhile, they can help you without an agenda. If you call a hospice (such as a national one), their focus is to get you to sign onto service no matter what it takes. Your doctor will probably refer you to the one that markets him the heaviest and they'll pressure you to sign on, or the one with whom he's affiliated.

Remember that the person with whom you speak (at the hospice) usually gets a commission or has a quota and is normally a sales person with little medical background, so their goal is not to help you as much as it is to get you to sign on. Call and only speak with a nurse who can help you understand how hospice might or might not benefit you. Call several if you want, but tell them that if they call and get a doctor's order without your permission you won't use their service.

You have the right to choose the treatment that your mother will receive. Personally and professionally, I don't believe that hospice belongs in a nursing home unless the patient has uncontrolled pain or symptoms. It's different in an asst living home, they can help the patient stay there rather than continue the revolving door of the hospital.

I'll post the book link. Good luck - and please let us know how your mother does.

My mother and I have had our house for 12 1/2 years. We are still paying our mortgage, which is in Mom's name, but the deed is in both of our names with survivorship. Will I lose the house if she has to go into a nursing home?

zobub:
If your mother has the ability to pay privately or has a long-term care insurance policy, you're probably okay - at least for awhile.

If your mother can't pay for her placement, Medicaid will view the house as an asset that can be sold after she dies in order to recoup the monies paid out for her care. The Medicaid program doesn't recognize joint rights of survivorship, so it would consider that half of the equity belongs to your mother and attempt to file a lien for the amount owed (as long as you have been half owner since before Febuary 2006. If not, there's a current eligibility problem as well).

Please note that Medicaid will "allow" you to stay in the house, but will require that her income be paid to the nursing home as her share of cost. Think of it as a deductible. In other words, you'll lose her income which it sounds like you need to make ends meet.

There is a chance that you can circumvent the lien process after she dies if you are able to show that you lived with your mother and that by doing so, you were her primary caregiver that kept her from being placed into a nursing home. This is something that you would do in the future, after she passes away.

To be honest, you should meet with an experienced elder law attorney - there is a fee, but it's worth every penny - to ensure that you protect your financial position. He/she can let you know what your options are in your state. This needs to be an elder law attorney who specializes in Medicaid eligibility and has experience - estate planning attornies don't understand Medicaid law.

It'll cost you, but it will be worth every penny.

Elliemae, From my understanding, Hospice is covered by Medicare and secondary insurances.

Are there Hospice institutions where my Mother could live at? Is that how it works?

http://patrick.net/nursing/survival.html

That's a link to my book, which shows the table of contents and allows you to buy. However:
marianne says

Elliemae, From my understanding, Hospice is covered by Medicare and secondary insurances. Are there Hospice institutions where my Mother could live at? Is that how it works?

About 2 years ago I posted the following info (follow the links). The numbers have changed but the programs haven't.

http://patrick.net/?p=16361
http://patrick.net/?p=16353
http://patrick.net/?p=16352
So, to answer your question, Hospice is a type of care and not a place. If you stay in a hospice-dedicated environment, you will have to pay room & board at a rate comparable to what you've been paying (or close). There are some non-licensed homes that take patients in if they're on hospice - but if you can afford it go for a licensed & certified place where your mother will be well-cared for and you don't have to worry about.

I met with a woman tonight whose father is in the hospital and they're getting ready to discharge him - she is considering rehabilitation in a nursing home which will help dad recover and give them time to figure out the next step (maybe moving closer to the kids back east). A hospice is sniffing around him, and the marketer told her that their inpatient unit would be a better choice for dad because they have private rooms and he'll like the food better. They omitted the part about how dad will be able to stay about 3 days and then he'll be discharged somewhere else - and that he won't be receiving any therapies like the physical therapy he's getting in the hospital acute rehabilitation unit. The hospice told the family member that you don't have to be dying to be on hospice. This is so typical of high pressure marketing tactics and it gives all hospices a bad name. The guy works on commission and will never see the patient or daughter again - so what does he care? I was disgusted, to say the least.

Ask the hospice your specific questions and if you like their answers, go with them. But speak with more than one to get a feel for what will actually be provided.

I hope this answers your questions.

elliemae

Thanks for the links, elliemae.

Now my Mom has a new infection called C-Diff. The are treating her with the less expensive antibiotic.

I see no end in sight.

C-diff is an infection of the stool called Clostridium difficile.

http://en.wikipedia.org/wiki/Clostridium_difficile

Try not to worry, unfortunately it's a common infection; but does cause diarrhea. You might want to hire an in-home caregiver to help out - or place her in a nh.

If she were on hospice they would pay for a five day respite, then send her home or help you place her somewhere less expensive. They might also pay for the meds because they are comfort meds. You should speak with your doc.

Thanks elliemae.

My Mom is not in my care anymore.

She is in a NH (SNF) since being released from the ER for the UTI.

Her Dr said 10 days to follow up on having an IV in for fluids...then she got the C Diff.

Before that incident, she resided in a small Residential Care Home that is in the process of becoming certified for hospice care.

Thanks again

Sorry - I didn't re-read your post and forgot she was in a SNF. I do wish you the best - I know that it's difficult to have an ill parent. Just curious as to whether you've contacted tthe Alzheimer's association for info & support?

ellie

oh yes I am a member.

You've hit it..Medicaid does not pay for long term care unless the person has assets within or below the poverty level or agrees to deplete assets to gain Medicaid benefits.

That story simply tells us that long term care is very unpredictable and risky, so it's crucial to plan ahead and cover the necessary areas before you enter nursing home or any facility. buying long term care insurance pays off, and there are ways to cut the insurance premiums. read this article for some tricks http://www.completelongtermcare.com/resources/how-to-save.aspx

Planning for long term care is not only a financial matter, it's more of emotional.

Sure, long term care insurance is great for those people who can afford it. You offer some cool options and those people whose assets are well above $100k will need a policy like this. Especially if they don't want to structure their assets to make them eligible for Medicaid.

However, people who have substantially less should see an elder law attorney and split their assets - they can become eligible immediately and they should do so before purchasing an expensive policy.

Does this apply to Texas as well regarding signing for your parents to be in a nursing home? What if no one signs at all, will they kick them out? I signed for my dad to be in because it was under duress. I was told I couldn't sign it on the Resident line. I told the Admissions administrator I was nervous about signing as responsible party as I didn't have the funds to cover the bills. Dad is now on Medicare only. Mom was next to go in the same nursing home - - all within 6 days of one another. She has dementia. Now they want me to sign her papers too. What to do? Help me!

Sasebone

Sasebone:

First, I'd recommend that you buy my book: http://patrick.net/nursing/survival.html

It's chock full of information, such as this. It also describes everything in minute detail (and tell everyone that you meet to buy it...) ;)

The nursing home is going to attempt to pressure you to sign, but have your mother sign her own paperwork or have them write that the patient is unable to sign. If you feel pressured and don't want to be contrary, sign but write this sentence on the financial responsibility pages:

"I am not personally responsible for my mother's bills."

While you're at it, ask to see the paperwork that you signed for your father and amend those pages to add the statement. Make sure that you write that on the pages that discuss pharmacy billing, physician's billings, and any other financial pages.
-----------------------------------
But don't freak out. They'd have to actually sue you to get any money out of you, and they don't want to do that due to the publicity nightmare and financial outlay. The important thing is that your parents are cared for - and that they can't make you do anything else if you don't want to.

You have so many other issues to deal with - if your parents are there long-term, the facility will have to apply for a payment source - and he might have a payment issue after the 20th day if he doesn't have co-insurance. Once again, I'd recommend that you read my book due to the multiple issues involved - it will answer your questions and help you figure out where to go from here. If, after you read it, you still have questions, please post them here and I'll be happy to address them

-elliemae

My mom has paid over $350 K over the past 3 years for skilled nursing care she needs. She has been giving them her income for the past 18 months, when they talked to her about medicaid is when she started to give then her income. She thought they were going to file for medicaid. She has be diagnosed as situational competent. In her mind when she started to give them her income 18 months ago, she thought she was on medicaid. She is bed ridden due to MS and depression and needs to be catheterized 4 times per day. She doesn't understand what is going on. Last week I received a 30 discharge notice kicking my mom out saying she owes over $100 K and she has 30 days to vacate. I believe my mom has just officially applied for medicaid last month and may get approval this year. The home is a special home for Jewish people and my mom is Jewish and was told by them when she goes on medicaid she won't be kicked out. Now she is being kicked out for non payment.
martyz@msn.com

If the person admitted to a nursing home or assisted living place has assets, why shouldn't they pay for his/her care? All of these strategies being investigated by the heirs to dump Mom's care on the rest of us - tsk, tsk, tsk,... And yes, do not become responsible for the care yourself, but that is a different matter entirely. I guess the hospital believed that the son bungled the Medicaid application process, and should be responsible for the loss.

Blurtman says

If the person admitted to a nursing home or assisted living place has assets, why shouldn't they pay for his/her care? All of these strategies being investigated by the heirs to dump Mom's care on the rest of us - tsk, tsk, tsk,... And yes, do not become responsible for the care yourself, but that is a different matter entirely. I guess the hospital believed that the son bungled the Medicaid application process, and should be responsible for the loss

So if someone works all their life, pays into medicare-the state will grab all their remaining assets. But if some bum who never worked, received welfare for life is admitted to the same medicare, they get all the same benefits and don't owe a dime??

Now Elimae speak it the English huh?

While I was ranting about the outright strong arm robbery that is our healthcare system. She said it was only because I hate the black guy in the White House.

Tenpoundbass says

Now Elimae speak it the English huh?

Sure - if by "now" you mean six years ago. Blurtman says

I guess the hospital believed that the son bungled the Medicaid application process, and should be responsible for the loss.

Hospitals (and other medical providers) have become much more aggressive in their attempts to collect monies. This was a nursing home - but there are laws in many states that make family members responsible for other family members. There was a lawsuit a few years ago where a guy lost because he was served by a nursing home under such a law, and he didn't attempt to fight it. The home won a judgment by default and the guy was totally fucked. tens of thousands of dollars.

lostand confused says

So if someone works all their life, pays into medicare-the state will grab all their remaining assets. But if some bum who never worked, received welfare for life is admitted to the same medicare, they get all the same benefits and don't owe a dime??

Someone who works all their life and pays into Medicare will receive all the benefits for which they are eligible. When someone spends down their money to less than $2,000 and is in a nursing home, they can apply for Medicaid to see if it will pay for their room and board. Wealthy people or those who plan well can become eligible nearly immediately by setting aside their finances.

No, it doesn't seem fair. But neither is life. If it were, Hillary would have pissed on Trump instead of leaving to hit the restroom.

elliemae says

And the nursing home won over $100,000 judgement.

From a judge or a jury? Never trust a judge. Always get a jury.

And he should have counter-sued the nursing home for fraud.

Also, he should spend the rest of his life advertising what happen to him because of Glastonbury Healthcare Center. The bad publicity will be worth more than $100,000. I would never do business with a company that would do such a thing. He should go all over social media and protest outside their center every day or pay someone to do so. It's his first amendment right. See how much the company likes all the attention that comes with that settlement.

lostand confused says

So if someone works all their life, pays into medicare-the state will grab all their remaining assets.

If you feel that way, perhaps you could write a check for the woman. Everyone else who worked their whole lives and paid into Medicare should then have to pay for this person, so that her heirs can keep the money? Or perhaps we should raise taxes more?

Blurtman says

If you feel that way, perhaps you could write a check for the woman

If you paid all your life into medicare-you should get better care and not the same as some bum who was on welfare and gets the same care. You have paid into the system for decades and should get proportional care.
Pull the bums of the medicare/Medicaid and you pay for them.

anonymous says

The Deficit Reduction Act of 2005 signed into law in February 2006 put a little crimp into things for a whole lot of people and most won't figure it out until it's too late.

So Dubya was the biggest socialist of all?

Dan8267 says

From a judge or a jury? Never trust a judge. Always get a jury.

Jury isn't always better Dan. Everyone has their biases, difference is only in numbers. Judge 1 bias, jury... whole bunch of collective bias.

Elliemae, thank you so much for sharing that. When I get home tonight I'm gonna print out a copy and put it into our estate binder.

lostand confused says

Pull the bums of the medicare/Medicaid and you pay for them

I think you may mean people who have never worked a day in their lives, including their spouses as well. I am not too sure how many people there are like that. Elderly immigrants are likely in that group, I suppose. But your main argument is that you should pay your way, I believe. So if you paid into Medicare your whole life, and then required care that exceeded the appreciated value of what you paid in, I guess it is out in the streets time, and no more care for you, granny.

Blurtman says

I guess it is out in the streets time, and no more care for you, granny.

if that is the way it works, it should be for the bums too and they should be asked to pay on their own dime. Insurance does nto work that way, you pay a premium and if you get sick, then the insurance company pays for it. They do not come and take your house and all your assets, if it goes more than your premiums. Bums on the other hand get a free ride for life.

elliemae says

The bottom line here is simple: Don't sign the admission paperwork for a patient in a nursing home. If the patient is able to sign for themselves, have them do so. If not, it's not your responsbility to sign the paperwork.

What if the elderly person in question can't take care of themselves and doesn't want to go into the nursing home?

FortWayne says

Jury isn't always better Dan. Everyone has their biases, difference is only in numbers. Judge 1 bias, jury... whole bunch of collective bias.

In a random sampling, having 12 decision makers with biases is better than having 1 decision maker with biases because in the set of 12 the biases conflict with one another.

zzyzzx says

What if the elderly person in question can't take care of themselves and doesn't want to go into the nursing home?

Zzyzzx, and elliemae will correct me if I'm wrong and I might be, it has something to do with billing for "Rehab".

Basically, if it's not Rehab, nursing home entry generally won't be paid for by medicare.

That's why you see 85 year olds with terminal illnesses, who would like to spend the next few months at home, denied Home Health Aides and forced to stay in a nursing home.

thunderlips11 says

zzyzzx says

What if the elderly person in question can't take care of themselves and doesn't want to go into the nursing home?

Zzyzzx, and elliemae will correct me if I'm wrong and I might be, it has something to do with billing for "Rehab".

Basically, if it's not Rehab, nursing home entry generally won't be paid for by medicare.

That's why you see 85 year olds with terminal illnesses, who would like to spend the next few months at home, denied Home Health Aides and forced to stay in a nursing home.

Perhaps I should rephrase the question. I know somebody who put their demented Mom in assisted living (dementia ward in assisted living). Her Mom keeps asking when she can go home, but she is too mad off to be taken car of at home because the dementia is bad enough that she needs 24/7 babysitting type of thing. It's my guess that the Mom didn't sign any paperwork. At the moment it's more of a theoretical question since they do have another 3.5 years of long term care insurance to burn through before it really becomes a problem, and at that point the person in question will be something like 88 or 89 and hopefully dead..

Ironman says

She most likely gave Power of Attorney and Healthcare Directives to one the kids, which gave them the power and control to make that medical decision for her.

True, that did happen, but then doesn't that pretty much automatically make the kid liable?