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Who are you caring for?
Which best describes their mobility?
How well are they maintaining their hygiene?
How are they managing their medications?
Does their living environment pose any safety concerns?
Fall risks, spoiled food, or other threats to wellbeing
Are they experiencing any memory loss?
Which best describes your loved one's social life?
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Mostly Independent
Your loved one may not require home care or assisted living services at this time. However, continue to monitor their condition for changes and consider occasional in-home care services for help as needed.
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What happens if a patient needs to stay in skilled nursing care permanently beyond the amount of time the government allows for Medicare to pick up most of the cost and beyond the days allowed? How is it paid for? Thanks.
And we should all note that there are very few Medicaid-funded facilities that provide the care that we want for our loved ones. I've checked out many in my mom's area, and have found only one that I'd consider acceptable. She's in AL now, but her LTC $ will run out in a year and a half. I can't afford anything but Medicaid or caring for her myself after that point. So I'm retiring earlier than I otherwise would and moving four states to (I hope) have her live with me. I have no delusions that it will be easy. I just pray that her health will stay at a level near what it currently is so that I can do the care provision (with hired care givers and respite care at times).
If SN care is needed, the progress in therapy should not be used as a reason to stop Medicare payments. See Jimmo vs. Sebelius below. You will have to fight to get the facility to go along with this, but when you show that you have done your research, they will cave.
Per Medicare @ www.cms.gov/Center/Special-Topic/Jimmo-Center.html Skilled nursing services would be covered where such skilled nursing services are necessary to maintain the patient's current condition or prevent or slow further deterioration so long as the beneficiary requires skilled care for the services to be safely and effectively provided.
Also Jimmo Settlement Agreement approved by the court on January 24, 2013 [PDF, 134KB]
If one doesn't improve under physical therapy, it can be stopped--this happened to my father when the therapist said "he is simply incapable of doing anything". My mother had physical therapy but gave up on it and soon became bedridden because she had too much pain in one leg (both of which contain metal rods installed during surgery after the femur in each broke due to osteoporosis). They both had to go back to private pay. (I didn't have the heart to tell my mother that her quitting physical therapy effectively cost her ca. $16K that Medicare otherwise would have picked up.) How ever, this nursing home "only" charges $210 per day (and $200 back then); I feel sorry for people who live in states in which it is much more expensive. My father only lived about 7 months after that while my mother is still alive at 93 after being in this home for 4 1/2 years.
Carla didn’t mention that the patient has to show progress w physical therapy. My mother w dementia refused to cooperate w physical therapy so I had to private pay..at a rate of $375/day. My mother would sit in shit all day till they finally got around to taking her to bathroom. Since she needed lift machine they required 2 people...long story short she’s been home for 13 months after being in SNF for 10 months. Medicaid home care still not kick in yet.
someone mentioned that SNF can charge whatever they want until a patient is accepted by Medicaid. Perhaps this is a state by state thing, but in Minnesota facilities that accept Medicaid at all are still governed by what they can charge those who do not have Medicaid, so the prices are pretty fixed among those facilities. Even one that never accept Medicaid sort of have to gravitate their prices to the state regulated rate to be competitive, unless they are really high end types for patients where money is not really an issue. Either way, even with state regulation, the pricing for SNF is about 10K a month. Many families cannot afford that for too many months.
I reported this on other threads, but I was very surprised to find out what I did this week. My dad is a veteran, but we were told by many at the VA that he can stay free at a VA contracted private nursing home IF he has at least 70% service related disability which my dad does not (luckily). And that is fair I don't think we or any one expect things for free just to get them for free. But this week found out that disability is not the only condition. If you are categorized in hospice, which my dad is, you can also stay free at a private SNF which has VA contracts. A lot of our elderly parents are veterans, and a lot of them declared to be in hospice.
Start your Medicaid app now. It took me almost 6 months to have my husband accepted. While answering for 5 years of financial history I was charged $3,300/ month before he was moved into nursing care. In some states Residential Care is nothing more than warehousing.They wouldn't allow me to set up a payment plan. I questioned Medicaid and they said that the skilled nursing home can charge what ever they want until he was accepted into Medicaid. I spent over $20,000 of our savings for that care. I feel for you because it may help to hire an attorney. Check their back round in Elder Care and Medicaid apps. You may need to become their legal guardian if you don't have a POA (power of attorney). I know how unpleasant this process is. I only wanted to make sure he was safe, yet when you don't understand the process you can easily be confused when talking to people who no more than you do. Very best of luck.
Medicare will only pay for the first three weeks (I think) of a stay after a hospitalization. After that they pay part of the cost for up to 100 days (I think). The patient has a copay of $167/day for days 21-100. After that, the patient has to pay or be determined eligible for Medicaid. If you think a family member is in a nursing home permanently, you should start the Medicaid application as soon as possible. Patients can stay in nursing homes as "Medicaid pending" under some circumstances. There should be a social worker at the nursing home who can help you with the application.
Of course, this assumes the patient is financially eligible for Medicaid. If the patient has funds, those funds need to be spent for their care before Medicaid will kick in.
Patient's who have no funds, or after they have used their funds, can apply for Medicaid. If they are qualified medically and financially, Medicaid pays. Note that not every SNF accepts Medicaid payments and if that is the case, the patient has to find one that does. For Nursing Homes, most do accept Medicaid.
A person can't stay in a facility past the time it's covered by Medicare unless the person can afford to pay out of pocket. Most people can't afford this. At some point the person or family is approached by the facility's financial people and/or social worker if it's been assessed the person needs more time there than Medicare will pay for. The family will have to apply for Medicaid on behalf of their loved one. As long as the family is actively in the process of applying for Medicaid the person can stay in the facility. Once Medicaid is approved they will back-pay the facility and continue to pay for the person's stay in the facility.
Of course up to the time your loved one runs out of money and get Medicaid, they pay from their own pocket. I don't know if the person is a veteran, but if so, there may be some benefits there.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
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This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
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You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
#2 Private pay or go to
#3 Apply for Medicaid.
Per Medicare @ www.cms.gov/Center/Special-Topic/Jimmo-Center.html
Skilled nursing services would be covered where such skilled nursing services are necessary to maintain the patient's current condition or prevent or slow further deterioration so long as the beneficiary requires skilled care for the services to be safely and effectively provided.
Also
Jimmo Settlement Agreement approved by the court on January 24, 2013 [PDF, 134KB]
www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/Jimmo-Settlement-Agreement.pdf
and
www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/jimmo_fact_sheet2_022014_final.pdf
and
www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/Jimmo-FactSheet.pdf
I know how unpleasant this process is. I only wanted to make sure he was safe, yet when you don't understand the process you can easily be confused when talking to people who no more than you do.
Very best of luck.
Of course, this assumes the patient is financially eligible for Medicaid. If the patient has funds, those funds need to be spent for their care before Medicaid will kick in.
Patient's who have no funds, or after they have used their funds, can apply for Medicaid. If they are qualified medically and financially, Medicaid pays. Note that not every SNF accepts Medicaid payments and if that is the case, the patient has to find one that does. For Nursing Homes, most do accept Medicaid.
If your loved one will run out of money, you apply for Medicaid, which requires that you be both medically and financially at need.
If there is a spouse who is remaining in the home, you really need to get an eldercare attorney involved in the application.