Any advice on how to handle a relative that doesn't qualify for Medicaid but doesn't make enough money to privately pay skilled nursing?

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Any advice on how to handle a relative that doesn't qualify for Medicaid but doesn't make enough money to privately pay skilled nursing?

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My grandmother is a 87 year old woman who was previously in a memory care facility, assisted living. She has dementia and had a stroke and became immobile and incontinent, and also now needed assistance to help feed herself. She eventually developed a pressure sore that has progressed to stage 3-4. The doctor says there is little hope that it will heal. Before it progressed we moved her to another care facility where she was better treated but the wound progressed. We were then informed that she had to leave the memory care facility due to the wound and go to skilled nursing. She was admitted to the hospital and has been there for a week now. They will not let her back in the original nursing home. The hospital case manager says that she is not able to be rehabed so no skilled nursing will take her. It seems ridiculous that the nursing home was permitted to kick her out because she needs skilled nursing, but now skilled nursing won't take her. The hospital wants to discharge her, but she doesn't have anywhere to go. She doesn't qualify for medicaid as she makes over the monthly income limit in pension and social security, but not enough to privately pay for skilled nursing. We thought of Miller's trust but are informed that it will take 45-90 days to be processed if not more and she is currently in the hospital now. She only has medicare. We can't take her as our work schedule isn't from home and my mother is disabled. It seems like there is no recourse and all anyone can do is give apologies.

Care Decisions Hospital Discharge Medicare Paying for Care Skilled Nursing Facility

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You tell the hospital case worker that no one can care for her at home , you work .

Tell them it would be an “ unsafe discharge “ for Grandma to be home alone with a disabled person . Use those words .

The case manager will have to assist to find a bed in SNF somewhere for her to live permanently , not in rehab . Her money will be used up until there is no more , then Medicaid will kick in and make up the difference each month .

These case managers assume someone will go back to where they came from or to rehab . Their goal is to discharge from the hospital . They do try to stick the family with the problem where an elderly goes if they can’t pay private pay because it’s harder to find a bed.

SNF often want someone who can pay private pay in full each month for at least a year or more. Case manager will have to find a facility willing to take grandma as Medicaid pending . This is work they are trying to have the family take care of . You could certainly call around and try to get grandma a bed . But the fact that the caseworkers job is to discharge grandma, have them help . They probably know which ones to ask first .

Be firm with the caseworker that grandma can not go home . They may try to tell you that they can set up some homecare , but it would not be enough based on grands memory care needs and wound care needs .

Good Luck .

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Reply to waytomisery

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Couldn't respond to your reply so Im replying here. She did sell her home 4 years ago unfortunately and makes over the income limit for medicaid, $3500 per month, was enough for assisted but not for skilled. So due to these situations, if we do medicaid pending the skilled nursing said we would get denied and have to pay back in full.

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It sounds as though GM is over the income limit for Medicaid, not the assets limit. If so, spend down or private pay won’t solve the problem. I don’t know the answer to this, but perhaps this clarification will suggest the answer to someone else.

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Reply to MargaretMcKen

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You are spot on. Her MONTHLY income is over the Medicaid limit even if she doesn’t have assets. A lot of people don’t understand that. In PA for instance, if your monthly income (SS, pension etc) is over $2800 or so, you don’t qualify for Medicaid period. It’s a terrible dilemma because you still can afford to privately pay for care.

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She can be admitted to the NH "Medicaid Pending".

Talk to the Discharge Planner at the hospital about that and tell them in NO uncertain terms that they will not be allowed to discharge her to any place other than a nursing facility.

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Reply to BarbBrooklyn

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Thank you, one of the skilled nursing facilities mentioned this option but stated if the medicaid application was denied, we would have to pay in full.

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Very important here to make sure nobody, no one takes her home. Every body in the family needs to make sure the hospital case manager knows that nobody is able to safely care for her at home. Discharge would be unsafe. Case manager needs to find a facility that will take her under Medicaid pending. Start the Medicaid process now, get the help of an attorney (using grandmother’s funds) if necessary, but the hospital needs to keep her until a facility is found. My father was in a similar situation, it took the hospital about a week to find a facility. Follow the other advice here you have been given first, it is spot on.

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Reply to mstrbill

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I read your reply , saying she would be denied Medicaid .
What happened to the money from selling her house 4 years ago ?
That can be used to pay for her care .
i guess she didn’t use up the money from the house to pay assisted living , if they are saying it would have to be paid back .

Who received that money ? Do they still have it available to pay it back to grandma for her care? Otherwise she will be denied .

This may cause quite the pickle for you all , because of the 5 year look back .
I don’t know that another memory care facility would accept grandma due to the wound care needed etc , but you could ask around I guess . I’ve seen some where some residents were really at skilled level of care . But usually it was a resident that had been there a really long time so the facility was willing to keep them .

She was paying $3500 in memory care ? , that’s cheap .

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Reply to waytomisery

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Has hospice been offered ?
Would the memory care facility she was at , take her back if she was on hospice ? Sometimes they will .

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You indicate she has no money but won't qualify for Medicaid. Why do you believe this? Did she gift large sums of money that will put her in a penalty period?

I think you need to learn more about qualfying for Medicaid long term care. Hire an eldercare lawyer to assist your grandmother with spend down plan to allow her to qualify. She can qualify by allowable expenses to spend down to her states threshold. Her social security amd other income will go to longterm care facility and Medicaid will cover the difference. Depending on State she is allowed to keep a monthly stipend for her personal expenses.

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Reply to AMZebbC

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Not surprised the NH won't take her back. Doc said she had a pressure sore that probably won't heal info that the hospital shared with the NH, which gives them an out not to accept her back, as well as they don't want to be blamed for the sore getting as bad as it has. Dirty little secret, many NHs use the hospital visit to discharge a resident if they feel said resident is a "threat" to their business.

Hospital may have a difficult time finding a place for her, sadly, especially info shared about this sore. Even if they can find one, it will probably be less than ideal, again, sadly.

Try to apply for LTC (Long Term Care) Medicaid anyway, she may actually get approved.

Good luck to you all!!

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Reply to cover9339

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kpeter you are going to have to do the following: Make sure she stays in the hospital until a facility will take her. No exceptions! Once a facility is found, have grandma sign the admission paperwork OR hire a lawyer to instruct whoever wants to sign HOW to sign to reduce any potential liability. If Medicaid is ultimately denied or delayed, the NH can potentially sue whoever signed to recover the costs. So, if there is someone in the family that doesn't have much to lose, maybe on a fixed income, no assets, etc. That would be the person to sign. I realize I'm not giving ethical advice as far as the system is concerned, but if you're looking for a way to help yourselves and grandmother, this may be an avenue to take. The first thing though is your grandma's safety comes first, so she stays in the hospital until they find a place for her.

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Reply to mstrbill

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Clearly you think you have grounds for doubting whether GM will get Medicaid. Why? It must be that she doesn’t need NH care, OR she fails the assets test, OR she fails the income test, OR she has look-back problems. Is it about B and the house sale? Or what? You must know what the problem is, why not be clear about it?

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Reply to MargaretMcKen

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I filed an appeal so my brother wasn't discharged from the hospital and I am trying to get him Medicaid but he obviously gets too much from SSDI and BWC so he's still stuck with Medicare for now and he needs Medicaid to be able to get in a long term care facility and he needs memory care but I guess none of that matters to them .

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Reply to Angelabigsis

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I would contact Hospice and they may be able to find a place for her or they may even place her in an In Patient Unit for a brief time until a solution can be found.
I suspect that a facility will "suddenly" find a bed if she is on Hospice. (Hospice typically means she would not be a long time resident)

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Reply to Grandma1954

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I can only speak for my own career as a nurse case manager. I worked at a large urban hospital. Hospitals can't discharge a patient who has no safe destination. GM can't return to her previous facility, she has no new facility and family is unable to care for her. Thus, no safe destination and no safe discharge. Medicare law gives you/GM thr right to appeal a discharge based on whether you think she is *medically ready* not because of discharge disposition. My advice: get an elder attorney for some assistance and guidance

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Reply to mrsand4

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There is something called the medicaid waiver program. The hospital case manager should be able to see if she qualifies. Good luck to you.

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Reply to Lily427

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Any advice on how to handle a relative that doesn't qualify for Medicaid but doesn't make enough money to privately pay skilled nursing?

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