This probably belongs in the parent caring for parent thread but this is not about a parent, it is about my brother.
It seems like the drama with the in-laws is quiet, so I now get to deal with my brother. Since I spend a lot of time here with all of you, I thought you might have some answers or ideas for me. Here’s the story. I have a brother who barely lives on his SSI in southern California. He is a cancer survivor and has a colostomy. He has also been clean and sober for 10 years. Prior to that, he was an alcoholic and drug abuser for 20 years. To make things worse he suffers from benign familial tremors…sort of like Parkinson’s but not.
He has been renting a room from someone but moved out when they wouldn’t turn the heat on in the house. He moved into another acquaintances house but health wise he’s getting worse. His shaking is causing problems, making it difficult for him to take care of his bag. He can’t stand or walk for any short distance.
He really needs to be in a nursing home type place but I don’t know what the rules are for SSI and Medicaid (Medi-Cal). I live 3,000 miles away and figure I might have to travel out to help. We have a lot of baggage, he wants me to take care of him like I did for our mother but I’m not of the same mindset. I also have a sister who will not help at all even though she lives about 100 miles from my brother. She’ll explain that she can’t because of her health which might be partially true, but the real truth is she is a selfish person and only thinks of herself. (another reason why we live 3K miles away).
Does anyone out there know where I can start? I’m considering calling adult protective services since he just turned 62. Thanks.
Is there a council on aging or something like that where your brother lives. They might be able to help you. Even a local senior center might have the contacts you need to get the info you need.
Admissions folks at skilled care facilities will be able to help,you too. YBH, you could,probably contact someone near you locally in terms of finding out the restrictions on receiving Medicaid and being in a skilled care place.
The easiest and probably best way to get placement into a nursing home what takes medicaid is doctor recommendation after a hospitalization. The social worker at the hospital found the placement since they are familiar as to who takes medicaid and who has openings. When you are on medicaid you are limited to the amount of money that you are allowed and if you are over that, you do a spend down program. Items like prepaying a funeral are allowed as part of the spend down. His SSI will also go to the home but he might be allowed to keep a small amount each month as long as he doesn’t go over the allotted amount he is allowed to have. Most nursing homes that I am familiar with (grandmother, father and father in law all ended up in one) have x number of beds for medicare and some have x number for medicaid. He will be evaluated as to the level of care that he will need and is capable of signing all the paperwork. You should not sign any paper work unless you want to get billed for his care. This will help you research the homes in the area in which he resides. http://www.canhr.org/NH_Data/CountyMenuHTML.html
Technically, the type of nursing home in California that is covered by Medi-Cal (as Medicaid is called in CA) is a Skilled Nursing Facility (SNF). They are licensed by the CA Department of Public Health. Many SNFs are very similar to hospitals, with lots of nurses, doctors who are on call and visit regularly, and many non-ambulatory and wheelchair-bound patients. SNFs provide the highest level of care.
In contrast, facilities that are typically not covered by Medi-Cal are called Residential Care Facilities for the Elderly, Assisted Living, or board and care homes. These are licensed by the CA Department of Social Services and vary widely. Some (perhaps many) do take people’s SSI checks - I believe most that do are small homes with up to 6 clients. The level of oversight and care varies tremendously. Staff often live on site. There is a concern that many staff at the smaller facilities in California are essentially indentured servants because their immigration status rests on being employed and having the support of their employer, or at least they are fearful that it does. Because of this dynamic, problems at these facilities can be underreported. However, if your brother is of sound mind, he should be able to advocate for himself. There is a “transparency” website that the Department of Social Services maintains that shows citations issued to these facilities. If your brother would be comfortable being with other similarly-situated individuals (younger SSI recipients, many of whom have previous addiction history), he may be able to find an option that will work for him. It helps that he is clean and sober now.
Good luck and best wishes to you and your brother.
I agree about admission directly from hospital. That’s what I did for him. It helped that the hospital could document the medical necessity need for nursing care.
Has an elder/disabled law attorney been involved to assess your brother’s situation at any point? They may provide another helpful lens for viewing the best way forward financially, as well as ways for his legal situation to be in order. Not familiar with CA, but some Councils on Aging may have help with sorting out nursing home placements in these situations. Could be worth a call.
Sounds like a bit too much on one plate, @ChuckleDoodle.
Call adult protective services in his area and ask for an investigation regarding his ability to provide for his own care. They may be able to help, especially if his roommate states that he will not provide ostomy care assistance, bathing or food procurement and preparation. That MAY get him places if you are lucky.
Hospital stay is the best and easiest way to get placement but only if there is a reason to have him ADMITTED. Many elderly (and others - happened to me recently) who go to ER these days are sent to “observation” for a day or two. That is in hospital care but considered outpatient care by Medicaid, Medicare and insurance companies. It will not get him the SNF admission.
While having him closer to you would be much easier for you, it does open up another can of worms since he would now have to qualify for medicaid in another state. It might also his SSI amount since what is covered by medicare and medicaid varies greatly by state. Do get yourself or another sibling if you have one, added to any bank accounts. Also look into power of attorney (voids upon death) and power of health. They are forms that most hospitals and homes will want a copy of. Then if you have to sign anything for him you sign your name and either power of attorney after it, or power of health. I actually bought a large, plastic according file for my sister and my self in which we keep all legal items and death certificates. Even though it’s been 8 years since my last parent died we are still cleaning up things and need the file. I bring my file any time we are working on closing something so that I have any paperwork that they might ask for.
Sorry, I’ve been away from the keyboard for a little bit (snow, work and getting ready for my next class). Thank you, everyone, for your replies. apparently, my brother was taking the wrong amounts of his medications which was causing most of his issues. He is living at his roommate’s ex-wife’s house… She has called us several times to talk about my B. The last conversation was that she noticed him taking too many pills. She got him sorted out, on a pill regimen and he can now take care of himself, walk, and stand without falling over. She is okay with him staying there. I might have a business trip to California next month and will make an effort to drive the 2 hours to see him. I haven’t spoken to him yet, he broke his phone and hasn’t had it replaced. Plus, when we talk to the landlady, she says he is sleeping on the couch- something that sounds very familiar. It does sound a little sketchy, but I am not his keeper. (and don’t want to be).
@GloriaVaughn - thank you for the links. I think I have a little time to get a game plan going. I do have a sister who lives 2 hours from our B, but she will not make any effort to help. Most of it is selfishness, the other part is her own (overinflated) medical issues). It is not worth talking to her about it. I mention her visiting B, she tells me she can’t- she’s too stressed… :{
My goal is for him to stay in California. He would love it if I offered him a place to stay with us. That is NOT going to happen. He made his bed, he can sleep in it. If I don’t talk to him before my trip, I may just have APS stop in and see him, just in case. He was supposed to come out for Xmas and that was when I was going to have him add me to his bank account and get the power of attorney forms signed. I may do that when I go out next month.