Bed bound aunt on Medicare, options

[Anonymous]

Anonymous wrote:This is going to sound heartless, but I don't mean it that way. If she is not safe to be discharged to her home, do NOT take her into yours unless you want her there the rest of her life. At the rehab hospital, if you tell them she is not safe to be discharged to home and you cannot take her, they will find a bed for her elsewhere.

No other facility will accept her - it’s all based on strict Medicare guidelines, not the whim of the rehab. The only facility that might take her is a nursing home that has a long term care bed, and OP’s loved one would have to pay out of pocket once her Medicare days are maxed out, or she has plateaued in rehab.

[Anonymous]

Anonymous wrote:If she is not walking, can she use a wheelchair?

My mother was told she is not safe to walk anymore. The assisted living moved her to a wheelchair.

I’m trying to understand why a wheelchair is not being suggested to her.

OP mentioned that she is a two-person assist. How will she transfer from a bed to the wheelchair? She would likely need a mechanical lift, and her husband would have to be able to assist.

[Anonymous]

I just went through this, but in MD.

Medicaid will only help you if you literally have no money to pay yourself. And I mean nothing. You are able to still own a home but all other assets must be used to pay for care first.

If there is a living spouse, Medicaid won't look to his income to cover her care.

There were no other programs to cover care available to us (sure some existed on paper, but they all had long wait lists or weren't open for application. These are not things you use when you need to move quickly. AND you have to reapply every year. They make this very difficult).

If you refuse to pick her up, and Medicaid finds that she has money/assets to pay, they will take her assets. You can't just decide that she can't afford it. And if she gets on Medicaid, they will take all of her income moving forward to cover some of her costs.

[Anonymous]

What is the medical prognosis? Has a doctor determined that the patient has less than a year to live? If so, a residential hospice facility may be appropriate.

[Anonymous]

Anonymous wrote:I just went through this, but in MD.

Medicaid will only help you if you literally have no money to pay yourself. And I mean nothing. You are able to still own a home but all other assets must be used to pay for care first.

If there is a living spouse, Medicaid won't look to his income to cover her care.

There were no other programs to cover care available to us (sure some existed on paper, but they all had long wait lists or weren't open for application. These are not things you use when you need to move quickly. AND you have to reapply every year. They make this very difficult).

If you refuse to pick her up, and Medicaid finds that she has money/assets to pay, they will take her assets. You can't just decide that she can't afford it. And if she gets on Medicaid, they will take all of her income moving forward to cover some of her costs.

Every state is different. The spouse can keep the house and some savings and other things but they put a lien on the house.

[Anonymous]

Anonymous wrote:Ultimately, the idea is that she spends everything she has until she does qualify for Medicaid. So you need to work with the social worker and figure out how to protect the spouse during that process.

You don't get to just say "assisted living she can't afford" because basically, she can afford it until she's out of money and then it's medicaid.

+1 this

Your aunt will need to pay privately for care once Medicare benefits are exhausted. She will need to spend down her assets until she is Medicaid eligible at which point Medicaid will cover her care. That is how the system works. I would recommend connecting with the local office on again to guide you through the process as this will be a longer process. The social worker at the facility can help set up services that are covered under Medicare but these are separate from caregivers which she will need to pay privately for until she becomes Medicaid eligible. Alternatively, she can pay privately to stay at the current facility in one of their long term care beds.

[Anonymous]

Anonymous wrote:What is the medical prognosis? Has a doctor determined that the patient has less than a year to live? If so, a residential hospice facility may be appropriate.

Inpatient hospice has strict criteria. A person must have clinical needs that can’t be managed with hospice at home, like IV pain meds. The length of stay inpatient hospice is usually fairly short.

[Anonymous]

Anonymous wrote:Doesn't Medicare cover home visits for elderly people who need assistance?

Generally no.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Doesn't Medicare cover home visits for elderly people who need assistance?

Generally no.

Medicare covers skilled home health on a time limited basis. This means an RN to come 2-3 times a week for 45 minutes to address a specific skilled medical need (taking care of a wound or teaching how to give a medicine or checking labs). Medicare also covers similar visits by PT and OT 2-3 times a week for 45 minute visits. There is an incredibly limited benefit for a home health aide for a maximum of 6 hours per week for a short period of time if the RN is able to document the need. This would not be adequate to provide the care that the OP is describing.

[Anonymous]

Just a quick note for people who aren’t aware. Medicaid dos a five year look back into your assets and how you spent them. To can’t just give away money to satisfy your spend down. You have to spend it on allowable expenses.

If you gave away money or spent it improperly, even after you’re destitute Medicaid won’t pay for your care. Instead Medicaid will decide what amount was spent improperly and how long of a period of nursing home care that amount would have covered. After that period passes the applicant will the be eligible for coverage. They are very serious about their review so keep records.

[Anonymous]

Anonymous wrote:This is going to sound heartless, but I don't mean it that way. If she is not safe to be discharged to her home, do NOT take her into yours unless you want her there the rest of her life. At the rehab hospital, if you tell them she is not safe to be discharged to home and you cannot take her, they will find a bed for her elsewhere.

Or she goes to her home with visiting nurses, ot, pt.
Let the discharge team work on this. It’s their job.

[Anonymous]

She is going to have to spend down her own money at a private pay facility. This is why many people purchase long term care insurance. If she didn’t go that route, this is what her own private funds are for. Not sure why you think there is some sort of public resource to pay for this.