Can an assisted living provider force you to give them control of a bank account or charge $50 for the patient's Medicaid copay and needs?

about the charge for the shower.
State regulations require "X" number of showers per week. (I was surprised to find this out and in Illinois it is 2 showers per week)
If MIL got an extra shower I can understand the fee. And if it took a caregiver (aide) away from doing someone else's shower that could make them out of compliance.
Personally I would be more upset that someone was fired because of the request not the $75.00 fee.
As to the fee that is charged if you write a check. many places will charge fees if you use a credit card and write a check or an e-check". There is more "work" involved. Generally an automatic payment does not garner the "processing fee".
$50.00 seems excessive to me. But both processing fees and convenience fees are legal you might want to check your state and see if there is a maximum amount that can be charged.
It also sounds to me that MIL's needs are not being met and maybe she should not be in AL but rather Skilled Nursing.
I would be concerned with can they deal with problems that might arise after insulin has been given.
I would be looking for a place that can better serve her needs.

MILHell, the situation at the AL is not ever going to get better.
They are clueless and incompetent.
To me the overriding issue is that your MILs level of care - insulin by injection, pain medication, transition needed - is beyond what this AL can provide or is willing to provide and what is happening to MIL - RXs not being dispensed as per script, bodily fluids and fecal matter left on skin - is actually causing or will cause serious medical issues to happen. It is not a safe place for MIL.

im kinda wondering if all this obvious incompetence is being done deliberately….. that the AL has found themselves with a resident whose care needs are way way beyond what the staff at a AL can provide. That someone cocked up badly in allowing MIL to reside there. It appears They are doing stuff that makes it difficult to be in compliance for payment so can use that as a pretext to send you all a Notice to Move and then the horrid care situation is going to lead to a care crisis… like wound care needed from the crap show MiL sat in, or some sort of diabetic crisis. Most AL do not ever have the need to have lower rate paid room&board LTC Medicaid beds to run their place; there are plenty of folks who have the private pay funds to pay for AL care; AL don’t need to rely on finding impoverished residents who can be on Medicaid.

The only time I’ve seen an AL ever having LTC Medicaid beds that provided a more skilled level of care was at a facility that was tiered, so went from IL to AL to NH or AL to NH. The AL side had just a few LTC Medicaid beds and they all were basically placeholder beds till someone in a Medicaid bed on the NH side died and then that AL Medicaid resident moved over to the NH. There was continuity of care easily happening as Nh staff could come over and do things. Freestanding AL just are not staffed to be able to provide lots of hands on care; AL “assisting” is more about helping them in daily life activities, like zipping up back of a dress, assisting in transition in the shower, helping them in&out of the shopping trip van. LTC Medicaid pays a fixed low rate, if MiL needs loads of staff time - which it seems she does - she’s a drag on their staffing for other residents. Paying extra for medication management is kinda standard for an AL to charge. But dealing with a resident who need daily insulin and whatever else her diabetes management needs is imho beyond the wheelhouse for AL.

what would be simplest plan would be for there to be something that staff notices that seem to be such that a trip to the ER / ED is warranted and so EMS is called; MiL gets transported over to the ER at a hospital (not a UrgiClinic type of place but ER at a full fledged hospital); ER evaluates her and she gets admitted to the hospital; and then the AL refuses to take her back (they will say “we cannot meet the level of care for her); then the discharge planner at the hospital will then have to find her a place & it will be in a NH as Mil has serious diabetes needs plus whatever else will be in that now nice & fat chart from her ER and hospital stay; that Mil is already on LTC Medicaid will be a big plus for a Nh as they know the $ flow will not be an issue.

TIA aka transient ischemic attack is often used as a reason to call EMS. TIAs are really subjective as to how they present. It’s easy for an elder who is ill or with dementia to look odd enough to have had a TIA. & 99.9% of the time the EMS will load them up and take them to the ER.

ThIs AL is not going to get better and neither is the level of care your MIL needs. Try to get her out, into a hospitalization stay (Medicare pays) and then discharged for rehab (MediCARE pays) at a NH then she stays permanently at the NH (goes back onto LTC Medicaid). Really stay focused to get beyond this clusterF of a AL and get MIL into a Medicaid bed in a NH soon. Good luck.

Last night when husband went to do the insulin shot, mother in law told him there was an envelope for him.

On Thursday, she had an appointment and he asked that she get her shower before the appoimtment rather than after dinner that day. He was told it was not a problem by the aide.

The aide was fired because it was not approved by management and we now have a $75 bill.

My husband is furious. This does not seem right.

Milh,

I, highly recommend, that your husband contacts the police the next time he finds her soaking wet and untended. This is actually neglect and is elder abuse.

By law the facility has to provide a detailed list of charges. They can't just help themselves to her money or charge extra.

I would tell the stupid sob that is telling you no to a Zelle payment is actually telling you they won't accept a ACH payment. It's a no fee transfer that is the same as an autopay and that's what ACH is, it doesn't give them access to take her money, it's a clearing house.

I think they don't know what they are talking about and from everything you have shared, they are guilty of elder abuse and are now trying to set it up for financial abuse.

Everyone that visits and finds her uncared for and sitting in a dirty diaper needs to contact the police, every single time.

This senior residence does not sound like a safe environment for your LO. My understanding is that only nurses are legally allowed to administer medication to patients - NOT aides. That in itself sounds like a huge legal liability for this facility. I'm guessing there are differences between states in regards to a ALF versus a SNF.

My limited experience with ALF is a resident is evaluated on a care level scale for how independent they can function. I don't know what the policy was for private duty nurses as my mother was transferred to a SNF when her care level needs increased. It was obvious the ALF could not provide that care level. SNF is required to have a nurse staff 24/7 which was not required in the ALF. Basically residents wore an ALERT bracelet and if they triggered it during the night then some night shift person would check in the room and call an ambulance. However, no one checked the residents during the night - they were basically shut in their apartments. The ALERT bracelet is only useful if the patient is actually able to use it during a health crisis.

The objection to the ACH is incidential charges that husband and I are paying now. Her account will overdraft.

Also, the administrator has no medical experience and is allowing aides to split pills with no doctor approval.

We know she is not in the correct place and if we give authorization, they have a 90 day policy. Who will pick up the charge when not if she is moved.

This was not the admission policy.

What is your objection to an ACH payment?

Thank you. We are writing checks now. They charge a $50 check processing fee.

The fee has nothing to do with medicaid. Are you trying to set up a bank transfer paying for someone's Assisted Living or LTC room and board charge.

Yes, in some instances there is a charge for doing this by the bank. Seems the AL is being charged by their bank to do this transaction so they are sending that cost onto the resident.

How are you doing this, wiring the money? Are they trying to set up automatic withdrawal? Your LO is on Medicaid and you are trying to set up somekind of withdrawal of their SS check to offset the care.

Is the resident going to live the rest of their life in this facility. If so, why not allow the facility to become ur LOs payee. The only problem would be, if they are willing to set up a personal needs acct for the small amt allowed deducted from SS?

I would talk to your bank to find out if there anyway that payment can be set up with no one incurring fees. Why is not mailing a check not enough?

An automatic withdrawal does not give then access to your acct. Its a once a month thing if thats how its set up. This does not give them access to the account. We have it done with one of our insurance companies.

The administrator today said we could not EFT or wire money without the $50 fee. It needs to be ACH by them.

Please help!

This morning my husband received 2 texts from the administrator.

1. They ran out of pain pills again and they will split them for the weekend.

2. "I sent out a letter a month ago with the ACH authorization form to be completed and returned or have to pay $50 processing fee starting in Aug. Were you going to return the form?"

I have left messages daily for omnsbudman. They have not called back. This does not seem right.

Thank you, Retired50. Two weeks ago, I had a disagreement with the administrator and had chest pains and went to emergency. I have an $1159 co-pay for what the doctor said was anxiety and panic attack. I am now on a 30 day event monitor and I dread to think how much this will cost.

It is not just paying her items, it is also co-pay on our health issues. Both my husband and I have been to emergency and have a $8300 deductible. It is tight.

How long does it take for the omnsbudsman to call you back?

My husband and I went out of town Friday evening. We were to come back tomorrow.

The assisted living would not allow the nurse we hired out of pocket to administer insulin shots twice a day to perform the duties. Administrator said liability concerns. We had to come back early. We found mother in law covered in urine, her walker on the other side of the room, and her help string out of her reach. No depend on.

Her chair is destroyed from the urine. The smell will not come out.

I would check as others have advised you, but do know that ALF often are regulated much less and much differently than nursing homes. They are often considered a sort of rental with services and your choice to be there or not. I sure wish you luck. Many also don't take Medicaid patients, and they don't have to. They can make that choice and often would rather those on medicaid move on. And of course they are actually not "taking control of bank account" but are asking you to let them withdraw the monthly fees automatically, which is easier and less time and bookkeeping for them. Most have regulations written as my brother's did that no more than the monthly fee will be withdrawn and if there are any extra costs the resident or the POA will be notified before withdrawal. I found it a convenience for them and for me as my brother's POA. I always got very timely statements.

The ombudsman is an independent state employee who fields complaints about ltc facilities.

In my state, there is an 800# you can call to find out who the ombudsman is.

You need to complain about the check processing fee, the missing items and the medication mis-management.

Information about the ombudsman should be posted in the lobby of the facility.

Thank you for your responses but I am confused. I have the letter in front of me and they are calling it "a $50 check processing fee."

Is the omnsbudsman the facility administrator? We have talked to her when MIL ran out of some medication she should have had left and the staff split pills.

This is all new to us.

MIL on LTC Medicaid waiver & it’s paying for AL, amirite?
&
I’m guessing this is all brand new for you two & MIL.

If so, imo both you/hubs & AL need to take a step back as there are errors happening on both sides…..
- AL cannot force MIL to make them representative payee for her SS.
AL cannot force a $50 copay. But can require her account to end ea mo at zero & if need be can require financial responsibility contract done btw POA & them in order for her to stay there. Right now she’s owing $ not covered by Medicaid & makes AL concerned. That’s what the $50 is for, unusual but not unexpected.
- AL needs to have an explicit & clear fee structure. If MIL not competent to understand, they need to review with hubs & you.
- Why is MIL continuing a supplemental insurance policy? If she’s on custodial care Medicaid (aka LTC Medicaid) then Medicaid can & should become 2ndary health insurance. She needs to cancel or suspend old policy. If it’s an option to suspend it, try to have it suspended. Otherwise cancel. Adios that $98 a mo.
- RX copays shouldn’t be happening as should be on whatever pharmacy system Medicaid uses. If it’s that an RX is not on Medicaid formulary, it needs to be switched over to one that is. If her doc writing script isn’t familiar with Medicaid in facilities, it may be the time to have her switch docs. If the AL has an affiliated MD or clinic that most residents use, that’s where I’d switch my LO too.
- cell phone / landline. Well if need she can do without unless she absolutely needs 1 & can totally on her own be making all calls. AL should have a landline that residents can use…. Now it may be a phone set up in a seating adjacent to biz office. Personally at $35 a mo, I’d pay that for her but tell her it’s going to be phased out eventually. At some point, Mil is gonna be calling y’all dzs & dzs of times a day, starting early AM & that phone is adios…
- the “car” & $800 yr ins + gas & maintenance. So 1K a yr.
Here’s the rub on LTC Medicaid & their continuing to own car or home….. they r allowed to have home / car as exempt asset for lifetime & eligible for LTC Medicaid as long as they are otherwise “at need” financially & medically. Financially means IMPOVERISHED. & means they do a copay of all income less that $60 personal needs allowance (a PNA). So if elder wants to keep old house & car they can BUT have no-nada-zero $ to pay a penny on them. So family needs to pay & do whatever to enable their elder to continue to own house / car; it’s totally on family to pay & pay till beyond death. If family cannot afford or doesn’t want to, then either they get sold or go to rot or go up for tax sale. Yeah it’s harsh, but LTC Medicaid means impoverished. She can keep car but on you to pay.
IMPT: Please realize that selling her car now will pose issues for her Medicaid eligibility as mo she sells it that $ is income that will take her over Medicaid max that mo & then becomes an asset that if it takes her over 2K in her bank account takes her over Medicaid asset max. She will become Medicaid ineligible.
- incidental charges. MIL is doing things that have an a la carte charge. If grabbing snacks, or saying “I want XYZ shampoo”, she will be billed. A resident commissary is not free. Is she competent to understand this?
- $50 on site beauty shoppe seems high. I’d ask to see the bill. She could have tipped $$$.
- could Mil have given chocolates to staff?

Imo a lot of the issues y’all are having are related to not understanding how narrow LTC Medicaid coverage is, what it’s requirements are and how things need to change once LTC Medicaid done. & this not only for elder but also for POA & family if elder is going to continue to keep old car, old home as family will have to cover costs till beyond death & then deal with estate recovery (MERP) if need be.

If beyond what Medicaid pays, it’s on family to cover those costs. If not done, she’s out of compliance & AL can do a 30 Day Notice to move.

NO! THEY CANNOT!!! AL facilities, nursing homes, rehabs... pull this crap all the time with a POA. They want to make sure it all goes to them even what they are not owed.
If you have POA tell whatever AL you're dealing with that you demand a written bill every month. After you get done scrutinizing it to make sure the dollar amount is actually owed, then pay it.
They have zero legal right to charge $50 for any "needs" that were not authorized by whoever is the POA (or by the AL resident themeselves if they're still handling their own affairs).
Also, when a person is on Medicaid there is no co-pay involved.
Whatever AL you're dealing with is trying to shake you down.
Don't allow this. Tell them plainly to go pound sand and stop threatening you with this shakedown. Let them know Medicaid doesn't have co-pays. Then insist on a written bill every month. Also, let them know that you will be speaking to the Ombudsman's Office as well as your state's Attorney General. Just for good measure.

Call the Ombudsman for the facility TODAY.

My husband is power of attorney. My mother in laws social security is direct deposited into her bank account on the 3rd of the month. He writes a check to the facility for $1368 and she gets to keep $60. The facility is stating that if we do not allow them to electronically debit her account, we need to pay them an extra $50 a month.

I do not understand why this happens. It is very frustrating. My husband and I have been fighting over money lately. Since the facility takes all of her check, we need to pay $98 a month for her supplemental insurance, $35 for a cell phone because the facility would charge $50 for a landline, $25 for prescription copays and $391 every 6 months for her car insurance so she can be transported to doctors. I am also spending over $100 a month on clothes because they disappear.

The facility gave me a list of extra charges yesterday $4 for a snack size bag of chips, $60 for a haircut since her beautician cannot go on there premises and $10 for dial body wash because the Dove I bought her disappeared. I took her chocolates Wednesday, yesterday they were gone, the staff was eating them. Her medications are all wrong.

We cannot afford all of this with the increased costs. I may need to get a second job or quit my job to do 24/7 care.

If your loved one is in an Assisted Living facility that is being paid for by Medicaid, then all of your loved one's income--social security, pension- is due to the facility as the resident's "share of cost". They are entitled to keep a small personal needs allowance each month.

Are you power of attorney for the resident?

I'm not sure what you are asking.

Can you clarify what your question is?

They are charging you 50.00 for your loved ones Medicaid copay?