ISO insight/advice on nursing homes, Medicaid, etc

[Anonymous]

Cross posting from off topic: My DM is near the point - perhaps past it - where she can remain at home on her own. My DF's protracted illness wiped out most of their funds and their house is under water. Does anyone know how we need to do to move her into a nursing home? At some point, her funds will expire and she will need to go on Medicaid. DH will not allow her to move in with us - she probably has undiagnosed personality disorder and would make my DCs miserable. As is, when we visit, she is sweet to them 60-70% of the time, then belittling them for the remainder. Belittle is probably too polite of a term to describe her overly harsh and unwarranted critique of their conduct. I just don't know what to do and appreciate any direction from folks who've BTDT.

[Anonymous]

I am sorry about your situation.
Your first step should be getting a power of attorney and adding your name to all accounts she has. That way you'll figure out where she is financially. You also need a medical evaluation to determine if she is of sound mind, and whether physically she is at a point where she is eligible for nursing care.
Depending on the state you are in, she may get a home health aide before getting placed into a nursing home.
Good luck!

[Anonymous]

Do not add your name to her accounts!

[Anonymous]

Anonymous wrote:Do not add your name to her accounts!

PP. You do need access to her bank accounts and adding yourself may be the only way to do that.

[Anonymous]

Anonymous wrote:Do not add your name to her accounts!

Why?

[Anonymous]

Anonymous wrote:I am sorry about your situation.
Your first step should be getting a power of attorney and adding your name to all accounts she has. That way you'll figure out where she is financially. You also need a medical evaluation to determine if she is of sound mind, and whether physically she is at a point where she is eligible for nursing care.
Depending on the state you are in, she may get a home health aide before getting placed into a nursing home.
Good luck!

One sibling already has power of attorney and name on all accounts. We know where she is financially. Regarding the med eval, I am not sure she will cooperate in going for it. Her mind is more of the issue than her body. Well, she is experiencing periodic incontinence when she sleeps but is refusing to wear adult depends.

[Anonymous]

Anonymous wrote:Do not add your name to her accounts!

[Anonymous]

If your DM won't voluntarily submit to a health evaluation, there's not much you can do unless call Adult Protective Services. You should feel no guilt about doing so. If nothing else, they can give you advice.

It will be very difficult to get your mother into a care facility directly from home. Like near impossible. Your best route is to wait until she's hospitalized. Once she's been admitted to the hospital, it's much, much easier to get her transferred to a care facility. I would advise you to start the medicaid process now instead of waiting until that happens.

FWIW - having been through this twice, I think it's wise not to have her move in with you.

[Anonymous]

Anonymous wrote:If your DM won't voluntarily submit to a health evaluation, there's not much you can do unless call Adult Protective Services. You should feel no guilt about doing so. If nothing else, they can give you advice.

It will be very difficult to get your mother into a care facility directly from home. Like near impossible. Your best route is to wait until she's hospitalized. Once she's been admitted to the hospital, it's much, much easier to get her transferred to a care facility. I would advise you to start the medicaid process now instead of waiting until that happens.

FWIW - having been through this twice, I think it's wise not to have her move in with you.

Breaks my heart that we can't do it, but I agree with DH's reasoning on this. And he is devoted to her - just realizes that she has toxic moments and does not want his children subjected to them.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Do not add your name to her accounts!

PP. You do need access to her bank accounts and adding yourself may be the only way to do that.

I would not add yourself. You just do online banking. We do it for my MIL. It was too late to get power of attorney due to dementia except to go to court so we just opened a new account and we pay her bills online. No big deal. Once she is on medicaid and in a nursing home, medicaid only gives you $75 a month.

[Anonymous]

Anonymous wrote:If your DM won't voluntarily submit to a health evaluation, there's not much you can do unless call Adult Protective Services. You should feel no guilt about doing so. If nothing else, they can give you advice.

It will be very difficult to get your mother into a care facility directly from home. Like near impossible. Your best route is to wait until she's hospitalized. Once she's been admitted to the hospital, it's much, much easier to get her transferred to a care facility. I would advise you to start the medicaid process now instead of waiting until that happens.

FWIW - having been through this twice, I think it's wise not to have her move in with you.

While this is kinda true, not really. We went through APS. In less there is severe neglect or abuse, they don't get involved. I tried hard to get someone involved. Now that was impossible. We did get a nurse to help a little with the nursing home.

It is not impossible to get a parent into a nursing home directly. Easy way is to do it through the hospital but we did do it. We moved my MIL cross country, she lived with us for about six months while I got it all done. It was very very difficult having her live with us. I wouldn't recommend it in less it is your only option as it was for us.

You cannot get the medicaid paperwork and submit it but it will not be approved till mom is in a nursing home. They will not do pre approval and that is the issue as the nursing home is gambling financially if you cannot private pay for a few months and it takes months to approve. Our casework was impossible to deal with and kept sitting on the paperwork - he was a huge problem. That is probably why nursing homes don't want to take the gamble as the workers are slow to process and don't care.

In less she has almost no income she will not get approved for regular medicaid - we tried on $1000 a month as the prior state allowed it but in Maryland you have to have a few hundred in income to get approved for medicaid. We applied and got my MIL food stamps but not medicaid.

[Anonymous]

The other option is to get some kind of in-home help. Montgomery County offers it but it is very difficult to apply for (the staff not the actual program). We tried and asked for it but just got a run around. It is income based and someone can come into the house for help. They also pay for adult day care but again, we could never figure out who to deal with as no one returned our calls.

[Anonymous]

If you truly do not know how to approach things with MIL, I would contact the local Office on Aging for their advice since they must get this question all the time. You may want to see if her resources are limited if there is any chance to get her into subsidized senior apartment housing with perhaps as mentioned an aide coming a couple of times a week to assist her as needed.

If you know her assets, could she afford to go into a place offering assisted and nursing care services as a private pay client for a certain length of time and then shift over to Medicaid. In this area, a friend was honestly told that if one can pay for three years privately or with insurance, then there is no problem adjusting to Medicaid, provided, of course, there are beds available.

You do want to be sure DH does have the Medical Care Directive and the her Health Care Directive has been completed. A Power of Attorney would also be good to get. Aging parent even with money are difficult to deal with.

[Anonymous]

OP here, thanks for all the comments. My DM's mental capacity is not consistent - would just be my luck that I take her and she rises to the occasion. Of course, the moment she is back home, she would probably regress - she is either afraid/bewildered or fairly angry. Very hard to help her when it is the second. While her physical condition is fairly okay, as I indicated earlier, she is periodically incontinent and refuses to wear depends.

DM is not in MD, but another state where there are not many assisted living centers which flow into nursing homes taking Medicaid. At first I thought about getting her into senior subsidized housing, but realize she needs someone checking more frequently because of the continence issue. As I think I mentioned her house is underwater, so that is an additional financial burden for us.

Lot of moving parts.

Thanks to all PPs who've mentioned something and remain interested in any other suggestions.

[Anonymous]

Very few states will pay for assisted living. In MD, there is an assisted living waiver that takes about 5 years to get through the wait list. She does not have to live here. All you need to do is call and put her on the list - no paperwork to fill out (if you are an MD resident). Medicaid will only pay for nursing home/skilled care, not assisted living.

Her house being underwater is not an issue for you in less your name is on it. My MIL owes thousands in credit card bills. We get a creditor call every once in a while and just tell them she is in a nursing home and talk to the nursing home as they receive all her social security. That usually stops the calls. They cannot come after you for the difference. The bank will have to take the loss when it is sold.

Have you looked at her medications for the continence issue. The caretaker who my MIL had caring for her put her on Ambien to knock her out so she'd have time for her boyfriend (MIL slept fine in our home). My MIL had accidents there and here until we realized she could not wake up to go to the bathroom as the drug knocked her out. We stopped giving it to her and problem solved.

Also, I would get an assessment for dementia in less she has always had the mental health issue. Dementia causes changes in behavior. My MIL said some horrible stuff to us living here. Prior to the dementia, never ever would she say those things. There may be more to this.