Assisted living/skilled nursing

Parent Cafe
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<p>I’ll try to keep this as short as I can, but hope to get some help from other “sandwich generation” kids.</p>

<p>My mom has been in a wheelchair for about 20 years, due to several severe fractures from falls compounded with obesity.</p>

<p>She had lived at home, independently, until she was evacuated for Katrina, wherein she went into an assisted living facility and has been there for five years now. It is private pay, and we have used the funds from the sale of our childhood home to pay for it. Cost started at about 2800 and is now at about 4500. She gets a bath a few times a week, all her meals, laundry, and many activities. She has been very happy, and we have not had to check up on her daily as we did when she was at home alone.</p>

<p>She’s had some recurrent cellulitis, and has developed a bad case of it lately, and even has a wound on one leg. Her leg is so swollen and heavy, that she was no longer able to transfer herself from her wheelchair to her bed on her own, and required aid from the staff. </p>

<p>As the facility is understaffed and cannot transfer her as quickly as she would like, they have sent her to a local hospital. The social worker called me yesterday and told me that it is very likely that she will be released in only a couple of days, (thanks, Medicare), and perhaps may be released to a skilled nursing facility, but it is more likely to return to the assisted living facility.</p>

<p>Hoping to get some advice/anectodal info from anyone who has gone through this. It’s possible the assisted living facility will take her back because they probably don’t want to lose the private pay client, but it’s possible she would go to a skilled facility, but that would only be temporary.</p>

<p>I am hoping to find a facility that has assisted living and skilled nursing, so she can transition from one to another when the time comes, but that may not occur for a long time. I don’t think one can just walk into a skilled facility and say, take me. It’s my understanding a doctor has to write an order and these are usually not long term, but I may be wrong.</p>

<p>My mother does have Medicare and Blue Cross Supplement, but she is not on Medicaid. I will probably start the process of looking into Medicaid at this point, as the funds are quickly depleting due to the rise in cost of the care facility and the length of her stay. My father did serve in Korea, and it’s possible she may qualify for spousal benefits, another thing I’m going to look into, to help out as well.</p>

<p>Thank you for any input. I’m heading out of town to check on mom and plan to stay indefinitely, but I’ll check back to this thread when I get access to a computer for any input.</p>

<p>You guys have been great with trips and colleges, and I look forward to hearing from y’all.</p>

<p>Montegut</p>

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<p>from an insurance standpoint, SN is not long term. if she was admitted in the hospital and may be going to a SNF, she has to be in the hospital at least 3 days for medicare to pay for the SNF. SN does have to be doctor recommended. Medicare pays for the first 20 days of SN (not assisted living) in full. for days 21-100 she would have a 141.50 copay for each day… however, that being said… her supplement probably pays that for her (most of them do). Do you know what letter plan she is under w/ BC? Depending on what plan she has they may pay that 141.50 for her which gives her 100 days SNF in full. At 100 days, she’s exhausted all of her SN of that benefit period. If she does wind up going there, that may give you more time to figure out if you need to move her or look into medcaid and whatnot. It may also get her rehabilitated enough that she can come back to her assisted living with no problems. That’s all I have. :)</p>

<p>Good luck!</p>

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<p>Speak to nurses and doctors at the hospital (with mom there so no privacy issues etc.) regarding the discharge plan to a skilled nursing/“rehab” facility, which would in theory help to get her stabilized to a place where she could live more comfortably back in assisted living. The doctor must order this, as noted above, and your advocacy on her behalf could help. If she goes to temp. rehab, your</p>

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<p>Doesnt sound like she will qualify for medicaid anytime soon. The military has an aid and attendance program for spouses, but it is also based on her financial status. The living arrangement you sound like you are looking gor is what is called a CAC facility <a href=“http://www.ncdhhs.gov/aging/ombud/cac/CAC_Essential_Guide.pdf[/url]”>http://www.ncdhhs.gov/aging/ombud/cac/CAC_Essential_Guide.pdf&lt;/a&gt; </p>

<p><a href=“404 - Page not found”>404 - Page not found;
I was going to be looking into these options for my dad, but he is not going to survive his current hospitalization, so it is a moot point :(</p>

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<p>Slight clarification to above. The skilled nursing will be covered under medicare A only if a skilled need is identified. Not routine assistance is activities of daily living (bathing, dressing, transfers etc). Those skilled needs can include but are not limited to things such as skilled wound care, IV medication, skilled rehab services. </p>

<p>Some of are the opinion that it is best to try to keep someone on part A as long as possible, but others think it is best to keep some of those part A days in case there is a need for another skilled stay in the future. </p>

<p>Medicare does not cover long term nursing home placement. But most facilities will assist with the application for medicaid once assets are getting close to the qualification point. This is “off the record” but it is often easier to find placement in a nursing home while there is still a fair amount of private pay funding left before hitting the medicaid point. These days there is lot number crunching at the facilities about the mix of private pay, medicaid and private insurance needed to keep above water.</p>

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<p>Sorry about your dad,jym.
Another thing to consider,Montegut, is that not all assisted living facilities even have medicaid beds. We are going through this now as my 90 year old MIL is running out of funds. The family has worked something out with the assisted living facility(which has a memory unit where she is at but has no medicaid beds in the facility), so she does not have to be moved to another facility with a medicaid bed but it means potential out of pocket expenses by her children(which were not anticipated). We are also looking into Aid and Attendance.In her case,she has little money left but I believe you can qualify for Aid and Attendance even if there is a decent amount of money left. It is worth looking into.Good luck.</p>

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<p>Your mother must be in the hospital for three midnights with “in-patient” status for Medicare and her Supp to pay for the subsequent skilled nursing care. It is critical that the hospital has her admitted as an in-patient and not “observation” status. You should ask the hospital and confirm her status – don’t assume she is in-patient. I have known Medicare beneficiaries to be in hospital beds and receiving medical and nursing care, diagnostic tests, treatments, medications, and food for multiple days, but they are called under “observation” status, not in-patient. When this happens, the patient is left with the full bill for any post-hospital skilled nursing facility stay.</p>

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<p>Thanks, sevmom. This whole sandwich generation stuff is a bear. I have a thread going on a very similar topic. One poster called it the “club sandwich generation” because with inlaws in the mix is adds another layer of responsibility.</p>

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<p>Yes, jym, between my 90 year old MIL and failing 87 year old mother (still living with my sister but that is getting pretty difficult), it is tough. I am heading to my mom’s out of state next week for 3 weeks to give my sister a break. Please take care. I saw your other thread and know you are going through alot.</p>

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<p>jym, I am so sorry to hear about your dad…{{{hugs}}}</p>

<p>montegut, DH and I have gone through this type of thing for years with one of our parents. I will send a PM to you.</p>

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<p>Thanks everyone.</p>

<p>bhmomma is right-- the facilities will be much more welcoming if there is $ currently available. Many fo the facilities know how to apply for the aid and attendance services/funds from the VA so they can help with that. I’d probably focus on finding the right placement for your mom and then letting them help you with the other paperwork. Good luck. I how exactly what you are going through</p>

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<p>DH’s Dad was discharged from a hospital to nursing home. When the Medicare days ran out, MIL applied for Medicaid so he could stay. He had been in a private room but found Medicaid will not pay for a private room so had to deal with various roommates ( in really bad condition) from there on out. It was a big adjustment for him. Just something to be aware when discussing possible scenarios with your aging parents.</p>

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<p>Does your Mom have all her mental faculties fully functional? The facility which you choose later on may be dependent on whether your Mom is fully cognizant of her surroundings.</p>

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<p>Duckmom was spot on – you need to be really careful about making sure that she’s been formally admitted to the hospital for at least three days otherwise neither Medicare nor any supplemental policy she has will pay for skilled nursing home care even if she needs skilled nursing home care.</p>

<p>I suggest you meet with the social worker/discharge planner to better assess options. Also, if the hospital attempts to discharge your mom without a plan you’re comfortable with, you can appeal that directly to the Medicare Quality Organization that covers your state and the discharge is stopped entirely until that process has worked through. We had to do that with my MIL when the hospital attempted to discharge her to a nursing home without ensuring that an uncommon drug she needed was available to the nursing home on the weekend. (It wasn’t.)</p>

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<p>This is absolutely correct. My hospital owns a nursing home and I just finished a financial evaluation of it. It can easier to get into the home if you have private funds - just make sure they are licensed for Medicaid beds so that when the funds run out you can apply for Medicaid and not have to move them to a different skilled nursing facility (SNF). On the ‘mix’ - it’s not just about profitability but about state regulation. In our state, a SNF is licensed x number of Medicaid beds but it’s really calculated on number of Medicaid patient days per year. If the SNF exceeds the number of Medicaid patient days per year or falls below the number of Medicaid patient days it was licensed for, they can be fined by the state, so we have to keep a very careful watch on things. It’s generally difficult to move a patient out once they become a resident, so the facility doesn’t want to end up with too many Medicaid patients. It’s a major balancing act. Also, even though private paying patients are more desirable, there is often a shortage of beds in an immediate area and it can be hard to get a patient into a particular home. Our facility has a waiting list of patients with $$$ waiting to get in. </p>

<p>Even though your mom might not be quite ready for a skilled nursing home, I think you are smart to look at your long-term options. Keep working with the social worker or a case manager - they are usually the most knowledgeable about what’s going in your community regarding skilled nursing. Good luck.</p>

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<p>We were looking into assisted living for my mother when her health started to decline and she could no longer live at home. The facility we almost ended up sending her to was very willing to work with her mobility issues.</p>

<p>Unfortunately, her health declined and she ended up in a nursing home, where she is getting hospice care.</p>

<p>Part of her decline was due to what I feel was substandard care she received during a rehab stay, so I will just say, from our hard experience, to really check out the skilled nursing facility you send her to. My mother had been at this rehab previously, but the last stay she started having issues with some of her chronic medical issues unrelated to the rehab and they were poorly handled.</p>

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<p>To jym, I am sorry about your dad. </p>

<p>Thank you to everyone for your input.</p>

<p>I’m printing up your replies, and thank you to northeastmom for your PM. I will read them on the plane tomorrow morning and discuss them with my brother when I see him tomorrow. He resides in the city Mom is currently in, and he is putting out feelers for facility recs. I am mom’s power of attorney, and with my son now away at college, I hope to be able to assist my brother with any move we might make.</p>

<p>I do want to add this in, since mom’s mental faculties were brought up. Mom is fully cognizant, but she has mental health issues and is on medication for those. She was coroner admitted when she was not on meds and had a brief hospital stay to be put on meds, but we were blindsided by the social worker in that case who sent mom home, totally independent, even though she was wheelchair bound and looney as a bird. So, I don’t have too much faith in the “system” helping us out, and I’m also not expecting her placement to be an easy one. My siblings think there is such competition out there, we’ll have no problem finding her placement, but as someone brought up, there is often a shortage of beds, especially for a non private pay person. </p>

<p>Just wanted to put that out there to see if anyone has any thoughts on whether her mental issues will play into her placement.</p>

<p>Thank you all so much for your help.</p>

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<p>Montegut, your welcome. I know it isn’t easy. Best of luck in finding the best place for you mother under the circumstances.</p>

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<p>Montegut –
My heart goes out to you. I have lived what you are going through the last eight months and you have been dealing with it for five years! </p>

<p>A couple of things I have learned during the past eight months – </p>

<p>*Every assisted living facility is different regarding the degree of disability they will allow. My mother lived in a neighboring state where she would have been required to be able to “get herself to safety” if needed and she had to be “continent” 100% of the time to enter an assisted living facility. We moved her to our state where none of these preconditions applied. Mom has been basically wheelchair bound the past 8 months due to a severe structural back problem and associated pain. She is 92 years old, has macular degeneration and very poor vision. She does walk short distances when the pain is at bay. She is incontinent at night. Her mind and hearing are fabulous! The assisted living facility in my small town allowed her to live there with those issues. She pays $5,000 a month for her small apartment; meals and snacks; laundry; the staff administers her medication; bathes her twice weekly; wheel her to the bathroom, meals, and activities; etc. The cost was greatly raised ($1,000 a month) because of her nightly incontinence. This small (25 apartments), lovely ALF has said they ‘plan to keep’ my mother for the rest of her life. The cost may rise to equal that of a skilled facility, but we would rather have her stay where she is if that option exists. </p>

<p>I bring this up for a couple of reasons. Since your mother has been at the ALF for five years and you said she has been very happy there, could she return after this hospitalization with maybe the outside help of home health nursing, physical therapy, etc. coming into the ALF to provide help to the staff for any dressing changes and to get her stronger? That would eliminate the need for a transition to an unfamiliar facility. Also, does the hospital have a rehab or a skilled floor designation? My mother has been hospitalized three times in the past eight months. After one hospitalization (for a small stroke) she qualified for a week stay on the rehab floor right there in the hospital. The other two times she qualified for a week “skilled” designation, also in the hospital. This was just a paper change and she stayed in the same room with just less nursing care. She returned to the ALF better than when she left each time after the PT and OT she received during that extra week.</p>

<p>The second reason it would be nice for your mother to return to her ALF is -
*I agree with what others have said about facilities being more willing to have you live there as a Medicaid patient if you started as private pay. We have been paying with money my mother has saved and now that it looks like she won’t be going home, we will sell her home soon. I brought up the subject of what happens when the money runs out with the director before she moved in. She said that they do not directly admit Medicaid residents, but they have never had to turn out a long time resident who has run out of money and gone on Medicaid. Mom has a monthly SS check of just over $1,000 a month and will qualify for Aid and Attendance once her “cash” reaches the $80,000 level (I believe - the local VA office says to apply when total assets are at $120,000 as it can take 4-6 months for a decision). We figure she has about 2 years of money before we will have to apply for A & A. Since your mother has been private pay at her present ALF for five years, it seems that they would be more likely to accept her as a Medicaid resident when the time arrives.</p>

<p>I hope this helps! MWP</p>

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<p>Can someone point me to useful links on Aid and Attendance? My mom has several of the same issues that Montegut described (broken femur that never healed, severely overweight, diabetes, congestive heart failure, circulatory issues, lymphadema, ongoing leaking of her legs due to fluid retention, etc. </p>

<p>My dad has been taking care of her for the past six years since she broke her leg. If something happens to my dad (retired military surgical nurse), we are all in a world of hurt. We have been sorely disappointed with the level of support she’s gotten from the military medical system.</p>