From rehabilitation center to ‘skilled’ nursing facility; what next?
My wife is disabled one arm paralyzed and wheelchair bound; needing the care that I cannot give her at home! She may also be having dental problems with pain that I cannot tell except strong breath.
Will it be assisted living or nursing home ?
"Thanks for sharing your experience.
I should be looking into Medicaid while spending down to poverty."
1) You should be consulting with an EC atty before "spending down."
2) Spend down ONLY applies to the patient, NOT the spouse.
3) Spend down shouldn't just be spending on whatever, it should be used to cover the facility, however much she gets from SS (and if she worked/has a pension.)
4) The home, car, and savings, etc would be considered "shared", but in general the home, car and AT LEAST half (possibly more) of the savings you get to keep for your expenses. This is where EC atty can help!
5) Do have a good talk with the rehab people, to find out what your wife's needs are/will be.
You can find EC atty through the following link, entering your zip code. Call several, find those who might give a free initial consult, make a list of questions, take notes AND ask for a estimate of their cost for help. It won't be cheap, but it is the best way to ensure you get what you both need. YOU should not have to impoverish yourself to get the needed help for your wife.
https://www.naela.org
From reading on other threads, if your wife qualifies for NH, check those in your area and find the ones that accept Medicaid, in the event that she qualifies. My understanding is that she can be accepted PENDING Medicaid (application needs to be done first.) If the EC atty/recommendations from rehab point to needing NH, she will most likely be accepted - they just have to wait for back payment (but this is where the "spend down" comes into play - EC atty can guide you, but any income that is hers would be used while waiting for Medicaid decision.)
You should take into consideration the rehab area. Regarding dental issues you most likely need to take her to the office of one. A basic cleaning may be the most you can hope for initially. It might be advisable to have her pre medicate with an antibiotic for that. My mother always does due to having had hip and knee replacements. I myself had the nightmare of experiences from an endodontist not prescribing antibiotics after a root canal and then starting with a weak one but that is a whole different story.
I think you are looking at NH rather than AL facilities with her needs you describe. I wish you the best with this search and decision. Difficult as this may be the right place may offer you some reassurance.
I should be looking into Medicaid while spending down to poverty.
It does not profit Medicaid to impoverish the Community Spouse who then becomes an additional burden on the State.
Since then, we revisited the EC atty for mom. Although I still would have moved her funds to the trust we set up, it wasn't until later that the EC atty said to contact him if/when she needed NH (she's in self-pay non-profit MC for now.) He also told me I should not be paying trust funds needed into her account or direct paying the facility, however, moving those funds to my account would incur several nasty results:
1) the IRS (and possibly the state) would consider this income to ME, and I would have to pay taxes on it and
2) turns out that SS/Medicare also has some kind of look back and can charge the person MORE money for Medicare. When I received notice of the big increase resulting in less SS money, I contacted them. They look at income, and they consider the trust money income, (starts at 2 years I was told by them, and mom just finished year 3 in the MC facility.) I questioned that, saying well, if the money was kept in her account/CDS, then it wouldn't be income, why is it now? Same money, just held in a different place!
The only good news was that MC is considered a medical necessity, so it is fully deductible (NH would be as well, only AL is not considered necessity, but some care can be deducted.) Result is that she is now at a no-tax status. This means there are more funds available for covering the cost of her care.
Personally, I find the "method" wrong, and until her funds are depleted, even if she had to move to a NH, I would NOT apply for Medicaid. There is no spouse at this point, so the only benefit is that her remaining funds could be left to us. Sorry, but I feel HER funds should be used for HER benefit, not ours and certainly NOT to use taxpayer money.
People cheating the system will cause it to go broke and then no one gets help.
As far as what that care looks like, ask the facility to do a needs assessment. Then ask them to help you find a facility that can provide the level of care that she requires.
I know that you feel completely overwhelmed and alone, but there are people available to help you navigate through all of this. Just ask.
One thing that I would recommend, when they start making noises about discharge do not let them just send her home. I found that they will say anything to get you to agree to take the patient home. This is an unsafe discharge because you can not take care of her at home, memorize that term "unsafe discharge" and repeat it until you get help finding your wife the care she needs.
I am sorry that your family is dealing with such a traumatic incident. You will find a way to live with your new normal.
In regards to the dental issues prior to her discharge from the facility, I would ask for a dental consult to assess any dental issues.
Lastly, I would start this process by talking to the social worker of the facility.
Note that "resources must be spent down first" should be qualified with the PATIENT's resources need to be spent down (Medicaid will determine how much that might be) AND don't just spend willy-nilly on anything, use it to cover any costs in the care of the patient (aides or AL cost.) Giving away anything and/or frivolous spending could result in a penalty (delay in getting access to funds.)
Also, curious why no SS - others have questioned this as well. Gov't job? That should have a pension associated with it, although the various costs in her care already could be dipping into savings. So long as one has worked the required # of years in a non-gov't job, one should have SS. (Gov't jobs can be federal, state or local, in which generally you pay into a pension system and not SS.)
best wishes
Are you working? Are you and your spouse on Medicare and SS? Do you have family? Etc.
You will not be impoverished.
for not having time to indulge but thanks to all for sharing thoughts and experience; I kick myself for self pity.
my wife had the stroke on Oct 21 thru Nov 14 was in ICU with all body functions failing . But she came out from critical condition and had been in rehab, Meanwhile my anxiety BP took me to Emergency twice . I am in no position to bring her home. Our Kaiser Permanente Medicare Advantage Plan allows some time in a post- acute care facility.
Down the line it is looking like spending savings down to poverty level for Medicaid. so be it.
Ask the SNF staff to show you how to help your wife clean her teeth. If there are any dental problems, rather than just hygiene having been overlooked lately, they should come to light then.
Is your wife's speech/communication badly affected by the stroke?
( I gather that patients can hear everything, intellect is retained and need a long time to come out of this )
The reason I ask is trying to establish what is baseline for her....can she swallow without aspirating for instance? Usually with time she will reach her maximum potential if she has not already.
When you have time, give her good oral hygiene. That strong smell may be pocketed food.
For your wife’s care, a NH will provide more support than an AL.
Good luck to you both.
My daddy had a stroke. It’s interesting how different strokes can be depending on the circumstances.
Daddy had his after his heart surgery. He was actually in the hospital recovering from his bypass when it happened. He was in ICU.
After he was released from the hospital he did rehab. No paralysis. His stroke effected his speech so I took him to speech therapy three times a week.
He would mix up words. Once he told me to pick up a gallon of paint for mom. I called mom and she had told him to bring home a gallon of milk.
An AL may not be able to care for your wife. Plus its private pay.
LTC can be paid by Medicaid. As a "Community Spouse" Medicaid will look at your finances and will split them. Your wifes split would need to be spent down. You will not be made impoverished. This is just an overview. You will need to talk to Medicaid because each person has a different situation.