My 97 year old mom moved into an ACLF 2 years ago with a promise that she would get on the Medicaid Diversion program within 6 months. Obviously that did not happen. I finally got her on Medicaid by doing all the paper work. She still has not received any financial aid by means of Medicaid and now has a share of cost to meet. Her doctor visits are minimal so meeting the share of costs is impossible. She has acute lymphoma, COPD, obesity, incontinence, and needs help with her RDL services. A new contract for living at the facility which includes her level of care was signed in October, 2014. On April 14, 2014 a new care plan ( which did not change from the existing care plan) was initiated and she was given an increase in her cost of living by $500.00 without terminating the existing contract which doesn't expire until October 30, 2015. Eldercare can not help her. Medicaid cannot help her. She has no money to hire an attorney. Is there any service available to help her with this legal question without having to put out money up front. Must she pay the increase or can she get evicted?. Are there any services available for people of this age?
It sounds like you may need a lawyer but $500 is a huge difference in monthly rent, plus this new contract sounds a little shady. Up at the top of your screen is a category "Money and Legal". Start there.
There's also a website that some people go to. Supposedly there are lawyers online that give generic advice for free. I've also heard that this website is a sham so I don't know for sure. I'm sure there is someone here that knows for sure and can point you in the right direction.
Have you thought about moving her to a nursing home? I get a little confused about the difference between some Assisted Living facilities and nursing homes. Where I live, a person with the level of care your mom needs would not likely be accepted by the Assisted Living facilities I've looked into for my mom; for example, they do not give medication or help with toileting and bathing. They will allow a home health care aid (paid for through Medicaid) to come and do those activities. Might be much different where you live.
Could the increase in the "rent" be due to her moving to a higher level of care? My sister works at an assisted living facility and every resident has a GERD score (have not idea what that stands for, but it measures how much help they need). Once they reach a certain level, they have to move because the facility cannot provide that level of care.
Do you have any powers of attorney? When your mom signed that new "contract" do you think she understood what she was signing? You might take that issue to the facility administration.
And mom has qualified for Medicaid, correct? Now I'm assuming that the ACLF participates in your states Medicaid diversion program (so that their stay in a ACLF will be paid for by Medicaid). Is this the case?
Now I bet the problem is with how the ACLF does the diversion as the vast majority of the residents are all private pay and so the contracts sent out are all the same as they are private pay contracts. Most states do not even do a Medicaid diversion for paying any assisted living or congregate living, so the fact that your state does this is good. (Like for my mom in TX, it is much easier to get them into a NH and onto Medicaid, rather than have them be in AL and wait for the very, very limited slots on the diversion program.) The # of AL who even participate in diversion is teeny tiny too and they basically fill the diversion slots from within their established residents. I would suggest you get all of mom's Medicaid info - like her approval letter and the letter that details her co-pay (this is called the "SOC" share of cost in Medicaid-speak) and go to the business office. If the ACLF is still participating in diversion, then mom's payment responsibility is whatever is her "SOC". The SOC is all her total income each month less a smallish amount that is called her "personal needs / care allowance" and it runs somewhere between $ 35 - 90 a mo (your state sets the amount). Now I assume that mom has been regularly paying her SOC - this is mucho importante because if they don't the facility can terminate the contract for noncompliance. Is mom totally good on all her payments to the ACLF?
How does the ACLF get paid, you write them a check? or are they getting direct deposit of mom's income? - personally I would not ever do a direct deposit but instead write a check and then place a smallish sum (like $ 150) in the ACLF patient trust fund account so mom can draw from this for her beauty salon charges, or other small things she spends on. The facility cannot require that they get the monthly income checks directly either, so if they say that, they are incorrect. (The only time the facility can require direct deposit is if there is a Miller trust done and your state requires under Miller for them to get it)
Often a facility will do their own take on the SOC and look at a the overall monthly income without deducting the cost of Medicare payment taken from SS or any insurance or other fees automatically taken from a retirement or annuity. If they are used to all residents are private pay, the bookkeeper is not taking any of the Medicaid rules into account when they send out the contracts. So that each month, the NH "bill" is not getting paid. So look into those figures to make sure that is all correct.
Now if at some point it just seems that the facility is just not trying to work with you, it may be time to look for a NH for mom. Some facilities just find that participating in a diversion program just flat takes too much office time (like at my mom's NH they do NOT take any LTC insurance as the reporting requirements just need too much time to be worth the payment when they can easily fill the beds with private pay or Medicaid.) The one good thing about this is that a NH will take Medicaid and there is no contract that can vary or change. They get paid what the state has set as the state reimbursement rate; mom just pays her SOC & nothing extra. So think about if you need to come up with a list of NH that take Medicaid. You know if your first choice is full, and another NH will take her, you can move her to NH # 2 and then move her to your first choice once a bed opens up there. Moving them is a PIA but can be done and without any penalty under Medicaid rules. I did it with my mom and it was really not very disruptive in retrospect. Good luck and keep a sense of humor in all this!
I'm guessing.
Is this an Assisted Living Facility of a Nursing Home part of a ALF?
Around my area medicaid indicates that you move from ALF to a nursing home.
TMK; are there any medicaid programs that cover ALFs?
Please explain what a Medicaid Diversion program is ?
I understand it, if a LO is in an emergency room, you don't have to take them back, it becomes the hospitals role to place the LO.
I hope someone will clarify?
It is not realistic to move her to another ACLF at this age. The next and last move would be to a NH but her mind is too good for that right now. She could be a counselor. She is not eligible for the Diversion program because she isn't "needy" enough! The ACLF gets paid by private parties (me) and her social security. Forget about extra money. ADL are just a must, diapers, support stockings, hair, reading material, etc! Before moving there, she was promised they would help get her on the Diversion Program. That never materialized and she was already moved and settled into this ACLF. The family is taking up the slack but definitely need financial aid before that runs out also. I have just submitted a new care plan and am also seeking legal assistance. We'll see.
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