What happens when all her money is gone?

Thanks for all your suggestions. Many things to consider now. I let you all know how things progress. Hope you all have a safe and Happy New Year.
Blade1

Blade1, I assume you checked with the AL recently and not just when Mom moved in. In this state many ALs don't accept Medicaid for new residents but will after long-term residents run out of money. That is worth checking first.

As others have pointed out, if Mom can't stay were she is, the next stop is probably a skilled nursing facility.

Good luck to you, and do tell us as this progresses for you. We learn from each other.

Blade, have you considered moving her now? Many places require private pay prior to going on Medicaid. We are looking for a facility with continuum of care with AL for L, and memory care for Mom. Though I think Mom will end up in skilled nursing fairly quickly. While it is against regulations many facilities here require private pay for two years prior to going on Medicaid. And that is not a bad policy. Those on Medicaid benefit from people that private pay, that is what pays the facilities costs.

If mom is 96 and in AL with dementia and the usual age related decline, then my suggestion is that now is the time to start looking for NH/SNF for her to move into before summer 2015. Forget looking for an AL that is on a Medicaid diversion program, at her age she is going to need a NH more sooner than later and you do not way to have to move her again. Personally I would not wait for her to run out of funds but instead look for NH facilities that take Medicaid and do whatever to get her into one within the next 6 months. Even if it means having to do a spend-down of 10 - 20K at the NH to get mom to the point of being impoverished in assets to qualify for Medicaid.

I got my mom to go from IL to NH and totally bypassed the AL stage. It can be done but there may be hurdles in having this done seamlessly.

My suggestions are:
- first speak clearly with mom's MD to see if they will write the orders for skilled nursing care needed for her. If so, that is fabulous as you will have to have medical orders for her to go into a NH/SNF & speak with the social worker @ her current AL to see if they have a sister facility that has Medicaid beds and if mom can go there as a "Medicaid Pending" resident. Medicaid Pending is pretty important as it means that for the period of time that her Medicaid application is going through the state approval, that the NH is OK in accepting whatever is her monthly income as her co-pay for her stay @ the NH. Otherwise she will need to be private pay at whatever rate the NH has till she is fully approved by Medicaid. If the current AL has no sister facility that takes Medicaid, then ask the social worker for facilities that do. I have found that the social worker is often much more candid than nursing staff, business office or admissions will ever be - state laws require social workers at facilities, so their jobs are not quite under the whim or geo-politic of the administrator or the DON (director of nursing who usually is the goddess and ruler of the AL & NH)

BUT if her current AL won't write orders needing SNF, then you are going to have to find a MD who will. All NH have a medical director and most of them have an existing private practice. You want to have mom become a patient of the MD who is the medical director of the NH that she will hopefully get moved into. Often the doc's will be the medical director of 2 - 4 NH too. Her medical file will need to show the need for skilled nursing which gets done by having her go & see her new doc every 4 - 6 weeks or so. What all this is doing is establishing a medical history to show the need for skilled nursing care. MD's who are also medical directors of NH know what needs to be in their chart to pass the medical necessity review for medicaid. For my mom, the appointment she had a bad H & H lab result and a 10% weight loss was when she got order for skilled needed. This was about at month 6 of regular visits to her gerontologist. She was able to move into a NH as Medicaid pending within the month. There are some other somewhat simple things that can be done to show skilled needed…..like change Exelon pill to a patch as the patch requires more skill to administer; or have an Rx compounded on site for better swallowing which also needs skill to be done. If mom is relatively healthy as a horse except for her dementia, she may need to be seen every 4 weeks for a few months to be able to get enough items of concern in her chart to show the need for skilled nursing. Keep in mind that most NH admissions are from a hospital discharge to the rehab unit in a NH & then they don't progress in their rehab so they stay in the NH. For those who are in IL or AL, well they don't have the fat medical chart from a hospital discharge to show need for skilled so it requires more creativity to do……

Now when you look at NH be very clear that mom will be applying for Medicaid and that she needs a facility that does admissions as Medicaid Pending. There are many good NH that take Medicaid. Now as mom is in AL, the NH may send out a team (1 nursing & 1 social worker) to do an on-site evaluation of mom at the AL she is at. Done to make sure the NH can provide the level of care needed. This can be tricky if the AL is being hostile about loosing another private pay customer, so you need to let the AL know that you are shopping about for a NH. Really at 96 mom is likely going to need a higher level of care in the near future and the AL knows that.

NH should have a list (1 or maybe 2 pages) of the documents they need to get from you regarding mom's financial situation, her insurance items, citizenship, etc. for review; which in turn the NH submits mom's Medicaid application along with their bill to the state (this is what was done for my mom in TX). NH reviews the financials to see if they would accept her as Pending. For my mom, documents were over 100 pages but a good 30 of that was her old-school life insurance policy from the 1960's as each & every page front & back was required. Mom's pre-need funeral was also old (1980's) and a dz plus pages. The list - well you might as well start now to gather items up. Mom will be getting her awards letters from SS and any retirement this month for what she will be paid in 2015 and those awards letters are needed for Medicaid and then also for the NH to know what to expect as your mom's co-pay or her "SOC" - share of cost to the facility. It is totally do-able but time consuming. Whatever is on the list has to be submitted too. This time of the year (Dec - Jan) is great as all income & interest and other asset related details have paperwork notification or 1099's issued so you keep them for submission when you finally need to do the application. If mom has been spending her assets & income to pay for AL, she should be OK for her application if her income is under your states maximum as it's pretty clear that her "pattern of spending" of her income & assets has been going to so it makes sense that she's finally impoverished at 96 or 97.

There is a caregiver story on this site from Tony Rovere about his adventure in getting his mom on Medicaid that is quite enlightening. Good luck in all this and try to keep your sense of humor going.

Is her dementia bad enough to qualify for a nursing home? There are nursing homes that take medicaid.

My mother's assisted living facility does not accept Medicaid. Is there any agencies I should contact about how to acquire Medicaid assistance?

Talk to the finance people at the nursing home about Medicaid.