How much does Medicaid pay for me to care for my Mom in my home?

I want to respond to what was being asked about Medicaid residents being treated differently than private pay in AL facilities. My Dad went into Memory Care, as a private pay, because we had too many assets for him to get gov't help but he was not safe at home. He was in 3 different facilities before he was accepted for Medicaid in Arizona. All three were Medicaid eligible when we placed him in the facility and all were very nice places. The ONLY difference that was clear between private pay and Medicaid was that once Medicaid paid the bill, the resident was to be in a semi private room. There were times Dad was still a single person in the semi private room because there was not a suitable roommate....but no change in the costs. Our share of his rental fee was $200 per month. We paid for all personal supplies...lotions, depends, shampoo etc, but also did that as private pay. Medicaid only covered the room rent, and later at the end, they started covering the cost of depends if being incontinent was part of the medical condition. He took part in all the same activities as everyone else did. He went on outings with others....and within the policies for the State Health Dept in AZ, it was REQUIRED that there be no difference in treatment other than Medicaid didn't pay for private rooms. Now, we could have paid more in rent....the difference between semi private and private....and even on Medicaid, he could have been in a private room, but he didn't mind the roommate, and in Memory Care, the residents were not in their rooms except to sleep anyhow. Their little cottage had a living room, kitchen and dining room, and all resident ate together and shared the living room. The bedrooms were furnished the same for everyone, but we could have brought in his own furniture and a tv etc. We did that for the first two facilities, but by the third place, where he stayed for the last two years of his life, he was no longer interested in having his own things, other than his clothes. I think if you have questions about the rules, you can check on line with your state health dept and look under AL or nursing home requirements. Memory Care falls under AL in our state....and there is a difference in staffing requirements and other expectations. And YES...if you smell urine in a facility, you should run away and never consider them! My Dad's facilities, all 3, were clean smelling and fresh and clean in appearance. One was an older converted house that held 10 residents. The other two were franchised facilities...one had AL in the main part, but an attached, closed Memory Care unit...and the last place was 5 cottages, all new and with the same floor plans, each held 14 residents and were staff with 3 staff on days and 2 on evenings and nights. All 5 cottages were inside a locked secured fenced grounds, so residents were never locked in their building, but could go out and walk around, could go to activities in any of the cottages, although the residents were assigned to cottages based on the severity of their dementias.....with like abilities together in one cottage for the most part. In Memory Care, even if the residents were in depends and incontinent, the staff were expected to take them to toilet before and after meals, upon arising and before bed time, and every two hours in between, because the goal was to encourage the residents to be continent. Most with dementia become incontinent not due to physical problems, but only because the brain doesn't get the right signals about a full bladder or bowel. So on their own, they don't sense they have to use the bathroom, until it is exactly time to do it. But with the staff doing the 'remembering' many can stay continent for much longer. So this is different than what happens in some nursing homes. I imagine the two younger girls were together in a room because they were of similar ages and thus would have common interests and things to talk about. I would think that they had some spending money though, even on Medicaid, as AZ had some rules about that too. It was not a problem for my Dad, as his memory was too far gone and all was simply provided for him. I hope this helps.

thank you, Joanne, maybe I need to move now while I can - no, I really do need to find out more about how things are here for the future, but it is good to know that things - at least in a good facility, where I think the real issue is, because if you're on Medicaid, you don't really have a choice, do you? - are pretty much the same

Hi Deb. I am glad I gave you some things to think about. My mom passed away several years ago. What started her problems, though, was a fall at our (husband and my) home. She was in the bathroon, where they say most home accidents happen, when she fell and broke her hip. That was the evening my world turned upside down for the next 5-6 years. She was in the hospital for three days, then I was given a list of acute care/rehab facilities for her transfer. I took off and checked out the three nearest our house. The one that was cleanest, best staffed and seemed to have the lightest mood (if you can call it that) was the one I chose. I had all kinds of paperwork to do after the tour, and arrangements were made for her transfer. She was not too happy, but she was only a few days out of surgery. So, she couldn't protest too much. All of the rooms had two patients in a room, and she was fortunate to share with a very nice lady. Her stay there was longer than most. That's when I discovered there were some differences in the facilities and insurance coverage! I don’t know about Medicaid, but Medicare covered 20 or 21 days. One of the most important things anyone can do is to dedicate a calendar to their lo's happenings, right down to to date of entrance, conferences, etc...especially financial transactions. Keep a folder with the calendar and every bit of information one can imagine with the caregiver. I wondered why they were not pushing mom to do rehab. I realized it was because they wanted to keep her longer. She had Blue Cross/ Blue Shield FEDERAL. Regular BC/BS adds some days to Medicare's days, and Federal adds even more days than that. The reason I know about this and made the recommendations is because I learned it the hard way. I had been buying Mom's Depends and special toiletries. I also signed her up to get her hair done once a week and for on-campus activities. My mom smoked, so I was also buying her cigarettes. (As an aside, anyone whose parents or los live alone and seem to be doing fine: Be nosey! Tell them you have heard of other situations where older folks needed money and wouldn't ask. When mom was in the hospital and acute care, I decided to make sure her bills were paid. She knew I was doing it, even told me where her checkbook and bills were. When my father had passed away around 10 years earlier, their large home and 3 acres on a major highway was all paid off. I knew how mom used to charge things and hide them in the car until my dad was at work, so I should have helped her if she had let me. I soon discovered that mom had spent every penny of daddy's life insurance and had refinanced the property 2 or 3 times because she let credit cards get out of control. If she hadn't fallen and had to sell her home and property, she would have ended up paying someone to take it! As it was, she barely had enough for a little nest egg, which I insisted she invest so that she wouldn't spent it all. Using pensions left by my daddy and his social security and what I was making at a part-time job, we managed to pay her bills and cut up the credit cards.)

Deb, I am going to have to get to my financial experience with the finances and Medicaid at the acute care and the rest of the ALF later. I had a post-cataract procedure done on my left eye this afternoon. My vision is beginning to blur, which is bringing on a headache. Or, maybe recalling those days I wondered if I would ever endure is making my blood boil?! LOL Who are you wanting to know the ALF for, your mom or someone else in the family? I need to read your bio. and I would know, wouldn't I? I hope you are having a pleasant evening or morning...it's still evening for me. I stay up late.

As the attorney pointed out how Federal Medicaid is applied is state specific. However. Many local programs are blended to serve the population on this program. It's important to remember Medicaid and Medicare are *health insurance* programs, they do not pay for the *custodial level of care* which is what you are talking about. There is (at least in California) a separate Medicaid based program called Long Term Medical that will pay for a nursing home but that is based on a prognosis that the patient needs at least an LVN to provide and or monitor care.

there are Medicaid programs that will pay for inhome care, however

HiChari, hope things went well with your eye situation; dad had that done as well. my mom and dad are actually both gone now, but guess I'd been trying to find out for hub's aunt and uncle been working with. Not sure if it's on my bio, probably need to check. It's just now early evening here for me.

My mom fractured her hip as well, maybe why she fell getting up out of her chair, but she'd been needing a replacement for a while before but her doctor wouldn't okay it, but he did then, but since it was still just a fracture and not a full-blown break we still had time to actually plan it, so even though she, too, was in the hospital for just around 3 days, we planned to bring her home and have her rehab there while I went up and stayed with her; they said, even though she hadn't been diagnosed with dementia or anything, that because she was so frail and somewhat confused - at least they thought, sometimes I wonder - story later - that she really didn't need to go in a facility and after reading your story, I think I'm really glad they felt that way - I was somewhat surprised by what you said but fits with a situation she knew about in one and don't think we were thinking about whether we'd have a choice as to where or not and that one I know she was adamant about not going to, where she knew somebody had ostensibly been placed for rehab and never came out and wasn't getting it, so...She had state - not welfare kind - but retirement kind; my dad worked for the state - insurance. One thing that did happen, though, was social worker came in with papers to be signed and mom didn't feel like fooling with them so had her give them to dad, who had always never signed anything without looking it over good, except that a year or so before this he had, which caused a lot of problems I had to get him out of, so I looked at and saw it was to place her in a facility but I couldn't do anything about with the social worker in the room but I looked at mom and she realized what had happened, so when sw left, son/grandson and I went and found the chief of nursing of the hospital; she told us to go find their lawyer while she went and talked to them; well, of all things, we found their lawyer's office all locked up and found he had left town without telling anybody or leaving their papers; however, when we got back to the hospital found they had been able to talk to them and found she was supposed to go home, so then her surgeon's nurse practitioner came in and was shocked to find me there, even though she was the one we'd made the arrangements with; she immediately left and came back with the surgeon himself, who seemed somewhat surprised himself, but think he hadn't been informed and had just assumed I'd just come in for her surgery, never realizing I'd planned to stay; when he realized that he said, sure, she could go home; turned out the np knew my aunt - by marriage - and they had planned for mom to go to a facility they were both affiliated, in the next town over, besides, without her realizing it till too late and expecting me to be gone and not know anything about it either. re life insurance, dad had had them cash in their whole life policies and pre-pay their funerals some time before that, for which I'm so thankful.

Medicaid does cover LTC, however

Deb, it IS good to know about facilities before you need them, because once it becomes an emergency, you would only be able to get into the facilities that had the open Medicaid beds...and yes....as those after me wrote about, some places play games with you!! When my Dad was getting bad, the caseworker and I WERE out looking at facilities for Memory Care....and she was smart enough to tell me that, we needed to only be looking at places that were Medicaid certified, even though we knew Dad needed to be private pay until the money got used up. Her reasoning....with dementia, it gets very hard to move the resident a lot...as they decline with every move....so we should not go into a nice private pay, then run low on money and THEN have to go looking for another facility and HOPE we could find a nice one with an open Medicaid bed in time. So we had identified a place that said they had beds...but then Dad became an emergency, in that we had to get him out of the house as he was becoming aggressive and dangerous toward mom. So he went in for a 72 hour eval, and the judge ruled that he could not go back into the home. THAT means, we find a bed NOW and move him in. Had we not had a place identified, we would have had a day or two to find an opened bed and would have to take what was available and generally what is readily available is the really crappy places! So he was placed, and we were told he was on the list for a Medicaid bed....but we were not too far into him living there when we found out that was a sales pitch to get us in....as they only had 10 certified Medicaid beds and all were filled and their entire memory care was only 20 beds. So they got him there, and then let us know that he might be private pay for years and years!! Therefore, it became necessary to move him anyhow some months later. I learned how to ask the questions....and to insist on the answers.... And basically, the good places will tell you how many Medicaid certified beds they have, and will tell you that once the person is in as a resident, they actually get first dibs on the Medicaid bed when they need it, and the place will work with you on finances to make it happen....but it takes knowing how to have the conversation. I was glad to have a casemanager from the law firm, who had that experience, because I sure didn't! When we were just placing Mom into AL last November, I knew the questions and the answers to expect before I chose a place. She is private pay....and this facility's expectation is that one will be private pay for around 3 years before getting into a Medicaid bed, but once you start as being a private pay, they don't want to lose you, so they help how they can. In this case, we knew that Mom would need Memory Care down the road, so they suggested putting her name on the list right away....pointing out that if she was at top of the list, but not ready, we could decline and she would still be at top of the list for the next upcoming bed etc. They also suggested that we apply for VA Aid and Attendance for Mom, as that would basically also be private pay money, and would help her last out the 3 years before Medicaid eligible. It's all so complicated....and so helpful to have people who WILL discuss the 'hows' and not just play games with us!

Hi deb, joannes and LCSW4Hospice. I didn't get to finish last night and might not tonight, but I do want to share what happened in our case with the acute care facility and indirectly health insurance. Mom was three days out of surgery and needed 24/7 supervision, RNs and trained rehab staff. It was a great facility and mom was treated like a queen. If she had only had Medicare, they would have had her up, walking and ready for release in 20-21 days. Since she also had a health insurance Bl/Bs Federal policy, that policy added more days at the end of Medicare coverage. Thus, no rush to get her out. I think I mentioned that I signed her up for an appt. with the beautician each week and a couple of other things that I knew would be private pay. Things settled into a routine. I paid the private pay and it was reasonable. Well, the coverage date was nearing, and the social worker told me my choices and gave me a list of facilities. When I got a two-week itemized bill, showing how much Medicare and the aforementioned insurance had paid, I was amazed! It was astronomical! Here is where my mind gets fuzzy, from the stress it caused or ? Somehow my mom had pulled the chord for a nurse during the night because she needed to go to the bathroom. All of us has had that go now or here feeling. So, being a tiny woman and able to slide between the rails of the bed, that's what she did. Surely she was heavily medicated. All added up to another fall or accident of some sort that caused damage to the hip surgery, which meant two weeks of personal pay. After I got over the shock of such an accident happening in such a well-staffed and secure place and made sure my mom was being cared for, I asked about specifics. When I was told how much the two weeks of personal pay was going to be, I went home to my husband sobbing. My dad had left mom well-off, but she was over her head in credit cards. We are comfortable, but the thought of paying for those two weeks and probably for an ALF and maintaining our retirement plans was overwhelming. So, I asked the social worker about Medicaid. That was an education in itself. As you know, you are allowed to keep your home and car. Mom's assets were my dad's two pensions and social security... When my dad died, mom and I put each other's names on our checking and my savings accounts. Otherwise, upon death, accounts are frozen. We did so with the understanding that, in my will, that money would go to my husband. Being an only child, I would have gotten mom's money anyway. The Medicaid rep. ran mom's assets, and MY accounts showed up. I explained that my husband and I had our money together, but the account in question was mine so that I could keep the rental money from a property that was mine before marriage. We called it my "mad" money. I retired in 2000 and receive a pension, so the "mad" money wasn't used often and was pretty substantial. The Medicaid rep. accused us of trying to hide some of mom's money in my account! I had to fight to keep myself together from worrying about my mom and then being accused of lying...and wondering if I were going to lose my money so that mom could qualify. I told her we could prove that we had put each other's names on the accounts when my father died. I had paperwork that showed the rental deposits as far back as she wanted. I could give her a copy of my will stating the money was my husband's. I told her my work background and that my personal reputation and professional respect were easy to prove. I, who have never knowingly done anything to hurt anyone and with an impeccable background, was being made to feel like a criminal. Worse than that, I felt that the rep. knew that and was enjoying it. I am sure she could have marked that account as legitimate or acceptable, but she gave me a deadline to get copies of the history of the bank accounts and 5 years of monthly statements from the rental property. I barely made it to the bank before it was ready to close and happened to find a friend who would research and make copies of the history of the accounts. He said he had never been asked to do that for Medicaid, because Medicaid had the information they needed or could request a fax. Thank goodness I am somewhat organized, so I dug out the rental statements and put them in a box. After visiting mom and acting as if nothing were wrong, I went home and fell asleep on the couch. This is a terrible thing to think or say, because I would like to think it never happens. I was talking to my best friend, who works with family services, and she asked me what I wore to the appt. I said regular clothes, skirt, top, pumps....she began laughing and asked if I wore makeup. I did. Then she said I was overdressed. I said well that shouldn't make any difference, plus I didn't think I was. She said I was naive, like she used to be. She said no matter how polite and businesslike I tried to be, whoever the rep was saw someone they could use their authority to intimidate. I don’t know? Maybe it was standard procedure and I was so distraught that I misinterpreted her attitude? I am just glad it's over. Mom was on Medicaid for two weeks. Her dr said she could not live alone. Fortunately, we found a great ALF (different from the Memory Care described in another post). We were fortunate after getting mom's credit cards paid off. With her pensions, social security and what I was able to contribute she lived on private pay at the ALF until she passed away. That was my experience with Medicaid, BTW, I don’t know what it is now, but Medicaid would have "given" her $35 for expenses.

My message to anyone considering Medicaid is to read the laws of your state. If you can afford a lawyer to advise and represent you, it would be well worth it. In previous posts, there are also resources that do not charge. Go to the facilities where somone you know might live. Get a tour and a brochure of the facility and read every word of it. Realize that Medicaid takes the income and gives $35 (in my mom's case). So, someone is still going to need to be around for clothing and anything that goes over their allowance. Read everything and make sure you understand everything. At first, some places look very pleasant, but be sure to ask about extras such as laundry, towels, sheets, beauty salon, nail salon, etc. I could go on, but the best way I can explain it is that Medicaid or private pay, it is more than just paying rent...it's like a la carte.

Deb, I hope I have addressed what you wanted. I apologize for asking about your mom. I read your profile and realize that both of your parents have passed. I am so sorry. You sound as if you are in contact with a lot of people. Sometimes that's good and sometimes bad, but you seem to know the difference. Good luck. Write any time. Chari

first of all, Chari, don't worry about apologizing for asking about mom; I'm just glad to know it's in my profile about both mom and dad; I think I mentioned somewhere I got active on here again re hub's aunt and uncle, if that's who you're referring to me being in contact with a lot of people?

But I'm wanting to know a little more about what happened with your mom; mine did somewhat the same thing while she was still in the hospital from her hip surgery; she had it on a Thursday morning and Friday night - Thursday night she was still pretty out of it, as in still quiet and asleep; she has - oh, sorry - had, always did - a hard time coming out of anesthesia, her main fear of having the surgery - just said all that to say that maybe on Friday she was still heavily medicated as well and I didn't think of her as being that small but I do think - I believe I was told - they've redesigned the hospital beds such that the rails aren't quite as inclusive as they used to be, meaning it's just easier to get around them; anyway, I'd been staying with her at the hospital but fell asleep, since I thought she was, but - am I glad? - something woke me up to finding her standing on the other side of the bed - I don't think she'd even tried to call for the nurse - when I got to her she said she was needing to go to the bathroom; only thing is, she still had a catheter and was trying to pull it out, now at the time I knew nothing about them but I learned about the balloon thing and how dangerous it can be but I had called a nurse but she got upset with me for letting it happen in the first place but at least she didn't fall and I think she did put alarms down after that but that's all, not sure she did anything to keep it from happening again, but at least it didn't even though I'm pretty sure I did go back to sleep but I don't understand why, in your mom's case, that mean two weeks of personal pay; can you explain?

Hi Deb. We and our mothers really do have a lot in common, right down to their escaping from their hospital beds. Thank goodness they are both at peace now. I guess the difference was that my mother's fall popped some of her stitches or opened a part of the incision and she was bruised and scratched. I just know when it was going to be private pay for that long, it was A LOT of money. This was a facility where they had acute care patients like my mom (24/7 RN on duty), and they had other levels of patients who needed less care and supervision.

As much as I would like to share more of my personal experience with Medicaid, I think I have overstepped my boundaries. There are more knowledgeable people here who can give you better legal advice and the way things are supposed to work. I am glad. If I had known more when I first encountered some of this, maybe I would have been better prepared to deal with it. Just remember reality isn't always the way things are.

I hope you find an appropriate place for you husband's family and that it is a situation everyone can accept. You are obviously a very compassionate person and are anxious for everyone to be OK. I wish you success and peace in your endeavors. Let's keep in touch. My eye is getting better, just not for long periods of time. Have a lovely day. Chari.

Hey Chari, true about our mom's, with the difference that mom didn't actually fall. Feel free to msg me; we do seem to have hijacked the thread but I am, even though don't guess really matters anymore, curious as to why you had to go private pay; that's the part I don't understand, not sure if it would be considered, in that sense, same as hospital; mom was in a small one, so not all were in as acute a need as her, either, but obviously they had 24/7 nurses there but doesn't mean they were in her room.

Definitely love that statement - reality isn't always the way things are - and there were things I definitely weren't told ahead of time, but surely the nurses knew

I am quite concerned about the situation with hub's family but it's possibly reached a point where I can't do anything about it, so somewhat moving on until or if I'm given opportunity again, with possibly closer issues looming. Have enjoyed it; again, feel free to msg me, Deb

Hi Deb. If you saw anything about the tornadoes and bad weather in the FL panhandle, that is why I haven't been able to respond. I must have busy guardian angels, because we are fine and our home appears to be fine. Some houses and townhouses were totally destroyed, and the residents had to be bussed to churches. It was a mess. If you have FB, CHECK "WEAR TV" and "BLAB TV." Our next-door neighbor has some leakage and some fencing down, and three houses down there two trees sticking out the roof. I was sick when the power came on and I saw how extensive the damage was. We were so fortunate. The length of our posts wasn't what I meant. I felt that someone thought I was giving you erroneous information. I don't pretend to know the intricacies of the law, plus they are different for each state. I was just sharing what happened in my experience. My mom was in acute care long enough for her coverage to run out and in two levels of ALF 5-6 years, and I was there almost every day. I got to know the residents and attended most of the entertainment they had. Some of the residents asked me to help them or I just sat and talked with them. I laughingly told my husband that half of the people thought I worked there, and the other half thought I was my mother's aide. (She has always been petite, and she weighed less than 100 lbs. when she was sick. I am big-boned and had/have put on a lot of weight since the day occurred that changed my life forever.) Hope you are having a pleasant evening. I am still shaken up from the tornado, and counting my multitude of blessings. BTW, you, my other friends here and this website are among those blessings. Chari

Hey, Chari, maybe I should have looked at your profile and seen where you were from; I did know about the tornadoes, not too terribly far from me, have a sorta relative little closer to you who I think was actually there, somewhat wish I'd known, youngest and I went down after Katrina, might could have come been some help if needed, been there, had them here about 5 yrs. ago, glad you're ok, we were/are too from then, but the area just below us was almost totally destroyed as well; I was actually at my dad's when they came through; that same youngest I had actually left here with his dad, but of course he was at work when they were actually coming through; I was so concerned but even though he wasn't quite old enough for his license/permit, even, he was old enough to drive and we just happened to have a spare vehicle - an old thing we didn't care for him driving around - mudding, etc. - anyway, he took it and went to a friend's with a basement - dare a policeman to do something, but anyway, he's a big kid, literally, so looked older, so no problem, but anyway, me, too, sick when came home and saw all the damage; fortunately they said our power wasn't off long but also thankfully we had prepared for it from an earlier incident, down to even having a gas light - that they forgot about while sitting in the dark, till I reminded them - duh. Now, didn't really see what you're talking about other than reminder that Medicaid is state dependent, which maybe not everybody knows yet, but hopefully we all do. I at least knew you were just sharing, as I was; we never dealt with Medicaid at all anyway; guess I'm still not sure about your mom; was she in one of those long-term acute care facilities? know they talked about sending my dad to one but guess still don't understand about coverage running out - that is, unless you're talking about rehab, which is what I thought you were talking about to begin with, where you're talking about Medicare coverage - maybe that's what you're talking about that people thought was erroneous because we're supposed to be talking about Medicaid? where at least full coverage Medicare is only 2-3 weeks? but I guess what I wasn't understand was if your mom fell, would that not have reset her clock, but maybe if she didn't go to the hospital? I'm sure that was quite interesting to be with your mom there at the ALF; in a lot of ways I wish my dad had gone. Your description of her reminds me of hub's aunt; I'm really concerned about that situation but my hands have been somewhat tied. Might prove to be an interesting day - hope yours is well, though I'm sure about the tornado, was quite unsettling here as well when we had ours but very thankful as well. So good to hear from you again.

Hi Deb. I will try to explain without the personal asides. I have to take habby to dr and do some other things. I'll write later. Thanks for your response. The closest to this tornado for me was Hurricane Ivan. Some are saying what I did, it was actually worse. Thank goodness it didn't tear up the entire Gulf Coast like the hurricane did. Sounds as if you have an important, decision -making day coming up. I'll be thinking of you and hoping it comes out well. Chari