Unique situation - Tribal Healthcare and deciding on assisted living

[Anonymous]

My MIL is at the point, that she needs to move into some type of assisted living facility. She currently receives all her healthcare through the tribal healthcare system and pays $0.

We are looking at facilities in her home state but all of her kids live scattered about the country. Being closer to one of the kids might make it easier but I cannot figure out the financial costs of giving up the tribal healthcare. She currently does not have secondary insurance with Medicare because her tribal healthcare is the secondary insurance.

Even if she stays in her home state, she most likely will need to move to the larger city within the tribal boundaries for a variety of reasons so should wouldn't be staying in her community.

I have no clue what the "average" medical costs with Medicare are but I suspect giving up the tribal healthcare is foolish.

She has some money but not a lot so conserving money is a goal. She also has a degenerative disease so possibly has higher than average medical costs.

This is clearly not a common problem and trying to sort out the actual medical costs under Medicare is not easy.

Any thoughts, advise, comments??

[Anonymous]

Does she want to move? What do other elderly tribal members who have her condition do where she lives? If the cost of living is cheaper there, consider having her stay there even if it isn’t ideal.

[Anonymous]

Anonymous wrote:Does she want to move? What do other elderly tribal members who have her condition do where she lives? If the cost of living is cheaper there, consider having her stay there even if it isn’t ideal.

She knows she needs to move somewhere. She lives in a very rural area so there just aren't many options unless she moves to a larger city. She does have family members that live in the closest larger city and she would still have access to tribal healthcare there.

The tribe doesn't have any assisted living facilities. I suspect that most elderly tribal members live with family members. Her mother lived in her house until she was well into her 80s but that won't be an option for my MIL. They do have some rental assistance so we are looking into that to see if she qualifies.

It would just be great if there was any way to have a basic idea of what the medicare costs would be if she moved so we could make an informed decision.

[Anonymous]

You could try talking to assisted living facilities near you, or in the target state. They have sales offices who could maybe help you understand what her costs would be with just Medicare. But I think generally you’d be required to spend down assets until qualifying for Medicaid.

[Anonymous]

Does she access specialist care at an IHS hospital? There is likely both social work services and benefits coordination available at the hospital.

[Anonymous]

What is the point of living to an old age if you're in a strange place, not in your home, living in a place paid for by Medicare, which will be awful? If she's happy where she it, she should stay and just take the risks, honestly. That's my plan. My mother moved into one of those graduated living situations near hear favored daughter, who then died months later. Now she has everything wrapped up in that place, living in memory care, three hours from me. I never see or talk to her, because she can't even answer the telephone or have a conversation. And I work fulltime with two teenagers, so going there often is out of the question. So I ask you, what was the point? She sits around by herself day in and day out. If she had stayed in her home, I could visit her and she'd be in her home, where she was comfortable. Assisted living is a sad life, especially if it's medicare.

[Anonymous]

Anonymous wrote:You could try talking to assisted living facilities near you, or in the target state. They have sales offices who could maybe help you understand what her costs would be with just Medicare. But I think generally you’d be required to spend down assets until qualifying for Medicaid.

Yes, she will need to spend down her assets to qualify for Medicaid. She would then have to move to another facility with skilled nursing. We have already toured several assisted living facilities in the larger city. It would just be great to understand how much faster she would deplete her money under straight Medicare vs. Tribal healthcare but alas it appears to be very difficult to understand the differences.

We are just hoping that we can get 7-8 years out of the money she does have before having to go to a Medicaid facility. It would also be nice if she could be closer to at least one of her kids.

[Anonymous]

Anonymous wrote:Does she access specialist care at an IHS hospital? There is likely both social work services and benefits coordination available at the hospital.

Not IHS but she sees specialists from referrals from tribal ran facilities.

[Anonymous]

Anonymous wrote:What is the point of living to an old age if you're in a strange place, not in your home, living in a place paid for by Medicare, which will be awful? If she's happy where she it, she should stay and just take the risks, honestly. That's my plan. My mother moved into one of those graduated living situations near hear favored daughter, who then died months later. Now she has everything wrapped up in that place, living in memory care, three hours from me. I never see or talk to her, because she can't even answer the telephone or have a conversation. And I work fulltime with two teenagers, so going there often is out of the question. So I ask you, what was the point? She sits around by herself day in and day out. If she had stayed in her home, I could visit her and she'd be in her home, where she was comfortable. Assisted living is a sad life, especially if it's medicare.

Because, she has Parkinson's and she is not a place to completely take care of herself. She also does not qualify for a Medicaid facility at this point anyway. We are trying to prolong that part as long as we can. She has already fallen in the middle of the night and had to sit there until someone came to help her. She lives in a very, rural place so home health services etc... are extremely limited. Staying in her home is not an option.

[Anonymous]

You might talk with a Medicare supplemental insurance broker. If she switches to Medicare she will likely want a supplemental plan and a prescription drug plan. These brokers are very familiar with Medicare rules and costs and there is no charge for the consult. Or call the state Ship counselor. Also no charge.

https://www.shiphelp.org/