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Geaton, a minor point, but I believe you can have some ADLs and still have Medicaid cover LTC; that is, custodial care may be medically necessary while some ADLs remain intact.
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Reply to Igloocar
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Geaton777 Aug 3, 2024
I'm sure you are correct, it's difficult to summarize what exactly qualifies one for LTC for the purposes of this forum. Thanks for pointing this out.
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Just a possibility OP – are you the ones asking for more services for your mother? If you think that the staff attendance on M is not enough, and are asking for more, that might make sense of the NH asking YOU to pay.
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mkhenriques06: Presumably, your mother (if she is the individual on Medicaid AND in an SNF), may not have extra funds to pay for a private sitter.
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No, not for a person on Medicaid in a Nursing Home! If you need to, please call the ombudsman and complain, but don’t think you need to pay out of pocket for a sitter. You don’t, and if the person in the facility is on Medicaid, obviously he or she doesn’t have the money either. The NH must take the necessary steps to ensure his or her safety.
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I believe they can as 'sitters' are usually required when there is a need for the LO.
It likely is a legal matter.

If a person reacts adversely to medication, they can 'act out' -
Unfortunately, finding the right medication is a trial and error - and can adversely affect the brain chemistry, causing the intended distress / negative physical and likely psychological reactions.

From my experience ...

While restraints aren't allowed legally (there are very specific laws/rules), some kind of item can be used to keep the person in a bed if they are 'kicking and screaming' to get out of the bed.

You likely need to call Medicaid as well as talk to the facility administrator about finances. They have very specific rules to follow.

Gena / Touch Matters
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Nursing homes that accept Medicaid are required to provide comprehensive care to their residents as part of the Medicaid agreement. They cannot require families to hire private sitters or caregivers, especially if the resident is on Medicaid and has no financial resources. Here’s why:
1. Medicaid Regulations: Medicaid has strict guidelines that nursing homes must follow to ensure that all necessary care and services are provided to residents without additional charges.
2. Obligation of Care: Nursing homes accepting Medicaid are obligated to meet the medical and personal care needs of their residents. This includes providing adequate staffing to ensure residents’ safety and well being.
3. Financial Protection: Residents on Medicaid are protected from extra charges beyond what Medicaid covers. Requiring a private sitter would be considered an additional charge, which is not permissible under Medicaid regulations.

If a nursing home suggests or requires a private sitter for a Medicaid resident, this could be a violation of Medicaid rules. In such cases, it is advisable to:
Discuss the issue with the nursing home administration to clarify their request and explore all options.
Contact the state’s Medicaid office or a local ombudsman for assistance and to report the situation if necessary. Ombudsman advocate for the rights of residents in long term care facilities and can help resolve such issues.

Ensuring the resident receives the appropriate care without undue financial burden is a key aspect of Medicaid’s protection for long term care residents.

For detailed information about Medicaid regulations and nursing home responsibilities, you can refer to the Centers for Medicare and Medicaid Services (CMS) nursing home information and the Code of Federal Regulations (CFR). 42 Part 483 outlines the requirements for long term care facilities, including the obligation to provide necessary care and services without additional charges.
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Reply to HaveYourBack
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TouchMatters Jul 20, 2024
Thank you. Excellent information. I'll print out and keep for reference. Gena
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They are hoping family will provide and pay for the sitter. They can try, just tell them LO has no money and either does family. They can't discharge LO because it would be considered an "unsafe" discharge.
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Why is a sitter being required?
Is this for your mom (you say in your profile she is living at home with Alzheimer's/ dementia so not sure if this is for your m om or another person)And is this person in a "nursing home" aka Skilled Nursing facility or are they in Memory Care or Assisted Living?
If it is for mom with dementia and the reason for the sitter is agitation, anxiety there are medications that can help.
And if this is for mom and she is on Medicaid I doubt there are funds to pay for a sitter. And the family should NOT agree to pay for a sitter. I hope no one has signed anything that they are responsible for any expenses.
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mimi1952 Jul 20, 2024
My Dad would get out of hand in assisted living and they would want to put him in dimentia unit. Luckly we had a little money, I had a friend with some medical background and she was not working at the time. She would go in overnight to stay with him. Much cheaper than than sitting service.
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In most states, Medicaid only pays for LTC. This is usually assessed as medically necessary by her doctor, and it usually means someone is bedridden and cannot do any of their ADLs, or has a profound illness/injury that requires 24/7 medical oversight. One must also qualify financially.

I don't think Medicaid pays for private sitters.

I'm not sure why a NH/LTC facility would require someone on Medicaid to have a sitter? Can you provide more info?
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