What is assisted living and is it covered by traditional Medicare or state Medicaid? I live in Texas.

Cat - just read your dads backstory. Imho he does not at all sound like someone who could be in AL. His care needs between cancer meds & his tubes, etc. are really skilled nursing care,

so he’s in a SNF right now, right?
Whats your concern with his care?
He’s there over 6 months so what has the every 3 mos care plan meetings been like?
Is the facility wanting him to go to a more specialized SNF?

Has hospice been suggested? If not, I’d try to get that for him. It’s a total ,medicare benefit. Hospice can bring in extra hands 3-5 times a week plus specialized equipment, nutritionals, bedding, personal care products. There are probably couple of hospice groups that already have clients at his current SNF. There might be one that is geared for cancer patients. My mom was in a NH & on hospice for 18 months, hospice for her was beyond a great benefit.

My Mom was in TX, VITAS & Southern Care were 2 of the bigger statewide hospice groups.

Also if dad in in Htown area, be sure to find out what the evacuation plan is for his facility. Hurricane season is upon us. Some places want you to sign off on a “will pick up” or “won’t” form. With his care needs, I’d really discourage you from going & taking him for an evacuation. SNF has to have a on-par facility that the SNF will move to enmasse if evacuation is called for and not just to sheltering in place unless they are way outside of mean tide & surge (like Conroe ok but LaMarque no). ALs don’t have to provide this btw.

Howdy, I'm in Abilene.
I'm from AZ and things are different but the same depending.
Make an appointment with Medicare/Medicaid and ask questions until they want to kick you out!!

Depending on where you're living in TX will make a very big difference regarding the good/bad elder law attorneys. They are in every State/city.
Here in Abilene, I have met a number of Elder Law attorneys due to my husband's job career. The ones I've met have helped me with some of my questions. I also have a great Trust team to handle Mom's assets.
Abilene is small and still a very country type town, but I love it for a City girl from Scottsdale AZ. You know and word of mouth about the good, bad and ugly regarding professionals. Jump in and make sure you're in control, don't let anyone tell you know unless they can explain that satisfies you, then go to the 2nd-3rd-4th opinion until you're happy and comfortable.

Assisted living is a facility between living in ur home or apartment independently and going to AL where they get help in some of their ADLs. Like dressing bathing taking meds. It is usually private pay. Medicare does not cover facilities only rehab for no more than 100 days and not fully. ALs are limited in their care. With ur Dads problems an AL would not be able to care for him.

He is really where he needs to be. I would see if he fits the criteria for Hospice care.

From your profile it sounds like your a Dad is currently in a skilled nursing facility after the hospital? If so does this facility have long term care? (In my area SNF, LTC, and NH are synonymous, but maybe not in your area). Anyway it sounds from your profile that Dad may be a little too far along for assisted living. In my area they don’t do much assisting, and don’t deal with wheelchairs, bags, changing tubes etc, at all. What info and help are you getting at his Care Plan meetings with the Social Worker?

This site will help you determine whether your father is eligible for Medicaid, anyway, meanwhile:

https://www.medicaidplanningassistance.org/medicaid-eligibility-texas

Woah, Catsmith, I just looked at your profile.

Where is your father at the moment? I'm sorry to muddy the waters even more, but has anybody suggested that he consider hospice services, of course in close discussion with you? I'm wondering what support and advice you're getting, and from whom.

ALs vary on services they do. I’ve found it’s basically like dorm living in there’s community spaces with regular meals; have transportation & scheduled outings & activities. Health care levels vary.... some geared to residents who are totally good on ADLs (activities of daily living) but might need a spotter for when they shower or zipping up clothing. Others may have larger nursing staff & aides and will help residents do “transitioning” multiple times per day (like get out of bed, onto potty, into wheelchair). Some have nearby pharmacy do RX delivery & on site flu shots (billed to Medicare). Some have MD who comes by & their fee is billed to Medicare part B. AL costs vary, tend to put extra fees on for beyond basics.

You might want to get an evaluation done on elder to determine what level of care is truly needed ahead of looking.

Medicare - federal - pays hospitalization & rehab (part a), doctor & other health providers like PT, OT Speech Therapist (part b) & RXs (part D). You pay into Medicare via FICA & from SS after you’ve retired.

Medicare does NOT pay for long term daily room & board in a facility unless it’s time limited situation like post hospitalization discharge for rehab. Rehab usually at NH that is staffed & equipped for rehab. Usual rehab scenario is first 20/21 days at 100% then up to 100 at 80% but ONLY if patient is progressing in rehab. Most elders enter a NH this way.... like have a fall, go to ER, broken a hip, hospitalization w/surgery then discharged to rehab at NH, not sufficiently doing rehab so off MediCARE. Then Cannot go home as can’t function on their own so stay in NH but transition from rehab patient to LTC NH resident and pay for their room & board either private pay, maybe LTC insurance or apply for Medicaid LTC if eligible. Majority of NH admits come via the post hospitalization route.

Medicaid is a joint federal & state program and administered uniquely by each state. It’s everything from WIC to NH care. LTC Medicaid in TX as in all other states is required to have dedicated funding from a combination of state $ & federal $ for skilled nursing care in a facility. That means care in a NH. Not AL.

What states can do is get federal waivers to move some dedicated LTC skilled nursing care NH $ to go to other programs. Some states do AL waivers. Most states do not do AL waivers at all.
TX does AL waivers but it is a very narrow & strict set of requirements for AL waivers so imho pretty none existent for AL for average elder.

why? TX has 2 types of AL:
- CCF, a continuing care facility that is essentially custodial 25/7 care. No Medicaid coverage at all. Btw most medication management falls under custodial care, so that alone not a “need” for skilled.
- CBAAL, community based alternative assisted living. These are on waiver list. TX Medicaid will pay. But has a very limited enrollment & seems anecdotally to be LTC NH residents who get better & can transfer to a CBAAL open bed at adjacent or sister facility. It has a very limited # of participating vendors. Again anecdotally for vendor, it’s a tiered type of facility that has fully staffed NH & AL adjacent under same ownership & resident move from 1 to another when the handful of CBAAL beds have an opening.

If you are looking to find from off the street an AL in TX that takes Medicaid waiver, not likely to happen. Your - in my experience - better off doing whatever to get your elder documented in their medical history to be “at need” for skilled nursing care in a NH. So they can get placed into a NH. & they “spend down” to become financially “at need” for TX Medicaid. Which is basically being impoverished.

It’s not simple but can be done. I moved my mom in TX from IL to NH and totally bypassed AL phase. It was abt showing documented & verified need for skilled in her medical chart. That’s why a care needs evaluation can be really important to use to see what the reality is for your elder. They may not meet “at need” criteria.

Catsmith77, Assisted Living is a step of care which is a level above a person living on their own or living in Independent Living facility, and level below a nursing home/long-term-care.

With Assisted Living a resident usually needs help with showering, getting dress, and may have physical issues getting around. Assisted Living offers housekeeping and laundry service, plus 3 meals a day. Physical therapy is also offered, plus activities.

Also with Assisted Living, usually it is self-pay, meaning the resident pays the monthly rent from their own retirement fund. Some places will accept Medicaid if the resident had started out as being self-pay.

Some States have Medicaid programs where a percentage of the Assisted Living monthly rent is paid, with the resident paying the remaining balance.

Otherwise, with Medicaid, if one cannot budget for self-pay, they would need to go into a nursing home where Medicaid will pay for room/board and care.

Medicare does not pay for room/board in any type of facility, except for short term stay in Rehab.

I know, this is all so complex. It shouldn't be so difficult.