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My parents bought spectacular long-term-care policies in the 1990s. I had to invoke dad's policy when he went to a memory care facility because he qualified as having a "severe cognitive impairment" and the policy paid for 100% of his facility expenses for 3 years.



Mom went to an ALF almost 2 years ago, confused, wheelchair-bound, unable to walk and to perform many of her activities of daily living. After her living at the ALF for 4-5 months they put mom into daily physical therapy and (unfortunately) they built her up just enough that she can function with a walker and is now capable of bathing & dressing.



NOTE: She is a fall risk and is hospitalized about every 4-6 weeks with a fall & head injury, so my belief is that she needs "stand by assistance" and is not capable of living alone. She has horrible balance, confusion, etc. She was hospitalized less than 2 weeks ago. So far she has broken her hand, her back, her shoulder and her ribs, all as the result of falls in her home since she turned 70.



I am working on invoking the long-term care policy but the insurance agency has already hinted that she might be too "capable" of performing her ADLs. Sigh...so if the policy rejects her, she will probably run out of money in a year or two.



I am an only child, mom has no other family or friends. I am not able to take her in or care for her, and, I will absolutely refuse. She is only 80 and her mother lived to 96 (so you see my potential dilemma).



I never ever imagined we would have to go down the Medicaid path. But, if the policy will not kick in, and she has established residency at the ALF for like 2-3 years, will they kick her out???????? I haven't broached the subject with the facility yet, I can't even discuss this out loud.



We are in Florida if that makes a difference. If they stick me with her my life is over. She has royally screwed the last 10-12 years of my life and honestly when she was in the wheelchair I finally had some peace.

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Check and see if the AL takes Medicaid. In NJ you may get it if you pay privately for at least 2 yrs. It depends on if the AL has reached their Medicaid quota or not.
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Upstream, if I recall, you have POA for mom.

Start by finding a CELA lawyer and pay for a consult about both the policy and Medicaid for AL.

They can't force you to do hands on care or have her live with you.

Did you sell her house; I can't recall?
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Upstream Apr 2022
Hey Barb! I am so happy you remember me. Yes we sold her house in 2020. I am her POA. I am very careful not to comingle any funds or take ANY money from her whatsoever. The money from the house sale was put into an account for her living expenses. When we sold the house, I found her a great little rental apartment near me, but she didn't like it and it became clear within a month of her moving there that she was not capable of living alone. There were multiple falls, the neighbors said she left at odd times, she hit a neighbor's car trying to park her car, and she ended up hospitalized for a long time, which is when she was discharged to the ALF as the only "safe" living arrangement.

What is a CELA lawyer?
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Do know that the final answer if all the news is BAD here eventually is NOT that your Mom move in with YOU. The answer, if there is no money, is that your Mom would have to go on Medicaid. Then she would be placed in a facility that accepts medicaid in payment.
This would likely NOT be an ALF, but you can certain speak with (and you SHOULD speak with) the facility to ask your questions. You needn't give a lot of information; you only are asking if they do accept medicaid payment in this particular facility.
Do know that most people do not have long term care insurance and most people cannot afford either in home care or ALF on their own savings. So Nursing Homes are often the final stop.
BUT the final stop is not your home and your life. Your Mom and Dad have had their lives. Your own life need not be sacrificed on some altar of care giving.
Wish you good luck. Taking this a day at a time for now, I hope.
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" She is a fall risk and is hospitalized about every 4-6 weeks with a fall & head injury, so my belief is that she needs "stand by assistance" and is not capable of living alone. She has horrible balance, confusion, etc. She was hospitalized less than 2 weeks ago. So far she has broken her hand, her back, her shoulder and her ribs, all as the result of falls in her home since she turned 70."

She may only be one more fall away from NOT being able to do her ADLs.
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You will need to prepare to apply her for LTC Medicaid. You do not have to be “ stuck” with her, and you can absolutely refuse to take care of her if she runs out of money to pay for the AL. You can help transition her to a facility that accepts her
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No one can "stick" your mom to live with you and you are not legally or ethically obligated to submit to this. Your parents have assumed you as their plan for their care in their old age. That's their mistake. You aren't responsible for her happiness, only to manage care that is in her "best interests" as her DPoA. Not to mention that the caregiving arrangement must also "work" for the caregiver so that it is not onerous to that person, which is what would be unethical, immoral, etc.

Medicaid is run individually by each state so FL will have different rules than other states. In MN where I live, facilities will have different numbers of Medicaid beds available (and they are almost always a shared room, that's why they are referred to as "beds" not "rooms").

I believe the Medicaid app in FL looks back 5 years on the finances of the applicant.

Facilites are not obligated to accept Medicaid/provide beds, so this question always has to be asked of any place before committing. Some states' Medicaid will cover some or all of AL and MC (I think Michigan does). So, you must be careful getting guidance on this forum since participants live globally. You should consider consulting with a Medicaid Planner.
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Insurance companies make money by denying valid claims. You need to appeal their denial. Have an elder law attorney review the policy and have an occupational therapist assess her abilities to independently perform her activities of daily living (ADLs) and any cognitive decline.

The elder law attorney will be able to determine if her medical profile triggers the insurance company's obligation to provide the benefits set forth in the policy.
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I would push hard for the LTC insurance to go into effect. It does not sound as though it has been denied if they are just "hinting." If your mom needs to use a walker to get around, I suspect she can't bathe, dress, etc. totally independently. Can she get all her clothes out from the bureau and closet? Put on her shoes? Stand or sit to take a shower, getting in and out, dried, dressed with no one there? If there is a waiting period before the LTC insurance will pay, you should have your mother apply as soon as possible to get the clock started. The AL should have documentation about how much assistance they are providing, and the insurance company is likely to ask for that so make sure the AL has good documentation. If they want your mother to stay, they should be motivated to document in such a way as to help her get the LTC insurance--not dishonestly, but showing the extent of the assistance your mother needs that they provide.
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You and I have a few things in common. I'm also an only child, unable to care for my mom due to health problems of my own. She needs a lot of supervision and the downside of being the provider for that is you have to listen to the constant complaints, paranoia and general negativity. If I ended up living with her (dog forbid), I wouldn't be long for this world. My mom, like yours, comes from a long lived family. My grandmother lived to be 97, my great aunt also 97, my great uncle 102. Both grandmother and great uncle had Alzheimers. I don't know how they managed financially, but long term care was less expensive back then. Mom, however, is sure to run out of money if she goes into ALF or NH.

I wish I had some sound advice for you. However, I'm at my wits end about what to do with my own mom and thinking a good Elder Law attorney is going to be part of the answer. I don't have high hopes though.
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