I’ve taken care of my mom since my dad passed away and she was diagnosed with dementia 3 years ago. She receives a VA survivors’ pension as well as social security. She also has Medicare and Champ VA which covers 100% of her medical expenses but does not cover long-term Assisted Living/ Memory Care or in-home care. I’ve spoken with so many people to try and prepare for the day when her needs surpass my ability to care for her, but I still feel completely lost. Her benefits are currently enough to cover some of the extra expenses I incur to rent a home with an extra room/bathroom on the first floor for her, to cover 3 days a week (approx. 24 of 168 hours a week) at a senior center, and to cover her basic needs. There is not enough money to cover in-home care or Memory Care, so those are not an option. When the time comes it seems like she will have to go to a nursing home, but I was told she cannot be pre-approved for Long-Term Care Medicaid to apply to nursing homes and that my only option will be to take her to an ER the next time she has a fall and refuse to bring her home. The hospital will then get her approved for Medicaid and will place her in a nursing home. Is this the only way? It sounds so traumatic.
Regarding the “no pre approval” into a NH, that is the system for the 3 States we dealt with. They have to evaluated in a facility utilizing skilled care in real time to be approved for “at need”.
FWIW the vast majority - like 70/80% - of NH admits come into a NH from a post hospitalization discharge. It does not have to be a ER dump, it can be that she is hospitalized for something more traditional then goes to the NH afterwards AND REMAINS.
Here’s the usual scenarios: mom falls & breaks hip / mom has a super bad infection; EMS called & mom whisked off to ER/ED (MediCARE pays); mom has surgery/ mom hospitalized as super sick & frail (as mom in hospital MediCARE pays); mom is discharged as a patient to rehab unit at a NH (rehab is a MediCARE benefit & @ 100% for 20/21 days, & maybe up to 100 dats at 50%); around day 19/20 in the NH & while still a rehab patient under MediCARE, it’s determined that she is “not progressing” in her rehab so MediCARE stops paying and at that point in time a decision has to be made to have her EITHER:
a. become a custodial care resident @ the NH. Custodial care is either private pay, LTC insurance or if income and assets are low enough the LTC Medicaid program. Mom will have a nice fat medical file from both hospitalization and rehab that clearly show “at need” medically for skilled nursing care which is a requirement for LTC Medicaid. & for LTC insurance filing as well. NH is happier as paid weeks of MediCARE rehab $$$, know medical “at need” aspect of LTC Medicaid eligibility is solid & have an idea of what the circumstances of the resident and their family is for being financially “at need” for LTC Medicaid eligibility & have gotten financial responsibility nailed down. (Imho the NH getting paid that sweet sweet MediCARE $ which is way waaaaay more than Medicaid is a factor in all this, just sayin’…)
OR this mom
b. returns back to her prior living situation or to living with her family in their home. & imho it’s pretty much on family to find & figure out how to get & pay for whatever inhome help and pay for it irregardless of whatever social services tells you will be available.
LSS Should your mom get real ill, you want her hospitalized; and when the discharge planner at the hospital calls you to tell you to come to get her, you firmly tell them you cannot as it would be an unsafe discharge as there is not the 24/7 oversight needed for mom. The hospital will figure out a way to get her into rehabilitation unit somewhere. Plan for this eventuality.
Start to pull together all her VA & SSA and banking statements and put them in a binder by year; you Dads VA stuff as well. Your POA. If she sold car or house last 5 years, find those documents as well. Because LTC Medicaid application can be quite narrowly time sensitive. You’re overwhelmed. But being organized will help. Good luck.
Unfortunately, if she has no money, I don't know of any AL that takes medicaid so her only option will be a nursing home.
Hopefully she stays stable for awhile.
I would speak with her doctors, your local council on aging, APS, and to be frank just about EVERYONE to find a social services method of applying for Medicaid for her when you are read. An "ER dump" as we call it should not be the only way; sadly sometimes it turns out to be the only way, however.
At the point that in home care is no longer possible do reach out. You will need to make it crystal clear that you can no longer do in home care for mental and physical reasons. Since she is already on Medicaid I would ask for a Medicaid case worker at the time you need it to assist your application. I hope you won't need to reach out to an Elder Law Attorney for guidance as this, too, is costly. But you may need to.
I hope others have ways for you to proceed with more ease and will be following your answers.