Mother is behind on nursing home payments. What can we do?

"Medical Assistance (MA) is Minnesota's Medicaid program." I know this to be fact; I've worked with Medicaid in Minnesota. I don't know how many other states administer it that way, but since Bunny says many people in her mother's facility are on county assistance, I'd wager a Cadbury egg that her state does it that way.

As others have said here go directly to the Ombudsman. Something seems amiss here.

bunny23, here the "county assistance" programs manage the Medicaid. Sometimes they have additional funds that cover things Medicaid does not. When my mother moved from her home county she got a new case worker, a new budget, etc. but not much really changed. Here some counties are more generous about things like transportation costs, etc.

I think the party you need to talk to is the county medical assistance program. I'd ask for a needs assessment and let them know that Medicaid is pending. If most of the ALF residents are on the county program it should be pretty easy for a social worker to explain how things work, what alternatives are, etc. Ask the ALF if there is a particular county social worker they work with.

In some states, ALFs are not covered by Medicaid. In many states that has changed, because, duh, ALFs are less expensive than NHs. It sounds like Medicaid in your state can be used for ALF and that the facility Mom is in accepts it. So there should be no need to move based on that kind of eligibility.

Bunny, many hugs to you! The country does a shameful job of how we take care of our elders. It is certainly hard enough (too hard, really) for family to deal with the impairments and illnesses of their loved ones, without having to learn to deal with bureaucracies and financial concerns, too! It sounds like you are doing extremely well under the circumstances. Once this financial stuff is behind you (and it will be), you can focus on the very challenging task of caring for your mother.

Please keep us informed! We want to follow you and also others may learn from your experience.

Bunny23, it sure sounds to me like the possibility of finding a way through this is good. The place she is in has been trying to work with you by the sounds of it and they must work with and be familiar with dementia and or Alshimers patients since she had that diagnosis going in and has been doing well there by the sounds of it so try to dial back the panic if you can, it will be much easier and less likely you miss options if you aren't as stressed and acting out of fear.

I would sit down with a pad and pen (old school so do it the way that works best for you ;)) to collect your notes. How long has she been there and what is different, if anything about her situation (both financially and medically) since she first moved in? Who dealt with all of the details when she was looking and when she moved in? I would be particularly curious about what was said and arranged at that time, they must have known about any gap in coverage and had a plan for that. I don't think any reputable non-emergent places like that admit new patients or residents without a concrete plan and everyone knowing clearly what the costs are and the plan for paying those. Since you now have POA you should have access to copies of all the paperwork they have on file. But include in this list who was involved when and any details about the changes in people handling various things that might be important (your sister and the social worker didn't see eye to eye or your brother lives far away and may have become hard to get a hold of because his wife's dad was having health issues too...) including changes and details about the AL staff or changes in mom's living area or daily schedule. Health changes and her medical team.

Once you have all the info about what the agreement was for these gap fees and whether or not your mom has been meeting her part of the obligation or not and why you can do some research on what other options people are offered (maybe she was too) and what other outside options do people use that may be available now or might have then even if they are no longer. Then you can talk to the right people with all the information and perhaps a little insight about new options and why they have changed their approach, which they seem to be doing, about this owed money when your ready. As long as they have enjoyed having your mom and things have been going well they have every reason to want to work this out somehow and you have every reason to believe they will.

It occurs to me that perhaps something has changed there and they are testing the waters with either all or certain patients they have arrangements with to see if they can expedite back payment even though they have an arrangement or maybe a new person has taken over billing and is trying to prove themselves, something has them changing their approach to your mom's standing agreement unless of course she has somehow that you don't know about yet. which brings me to another possibility, I have to ask could it be that your mom has become harder to handle or less pleasant and manageable somehow but not to the point where she has met the criteria to evict her so they are trying to squeeze her out somehow? Not saying this is likely the case I just know that the possibility exists for all of us at any given point so it seemed important to mention and even if this is the case it's often something that can be resolved...we read about how UTI's create different personalities all the time and are just as easily resolved, many personality changes can be managed once looked at as something medical rather than inevitable. I had a grandmother who became easier to be around and talk to as she got older! Again by accumulating this info (you may answer a lot of this simply by putting it on paper from memory) you not only start to formulate a plan of action you may very well figure out what is going on and what will fix it, the part about dark possibilities aside. When things are so up in the air and hectic for me, too many balls in the air with my moms care doing this often helps put things in perspective and more often than not the problem becomes very clear and solvable. Good luck :)

I like the answer was there a gap from private pay to Medicaid, and that is considered assistance. How can Mom "pay back" if they already take the money she has? Yes, I am still confused.

I placed my Mom in an AL on private pay. Her SS was going towards the upkeep on her home. Her little pension was going to her personal needs. Then the money started to run out so I applied for Medicaid. After 8 months in an AL I placed her in LTC. She paid two months privately. The NH became her payee for SS and pension. It was a smooth change over. She has a 6k lean from Medicaid that will be satisfied if/When the house sells. I am not responsible for it.
So I am wondering...why does she owe anything. Paperwork didn't get filed for Medicaid before the money ran out? Like said, a gap in payment while they waited for Medicaid to kick in? Hard part is not being there to see what your up against with my own eyes.

If you remove her ck first w LTC that they will continue payment for new spot. Call them as many times as you need. We really didn't know all when we took out LTC till needed. Every question call keep date & who spoke to. Also write letter which because of letter w questions made an adjustment of beginning 90 days.

97yrold - “bridge loan” is interim financing.
Using “bridge loan” in the context of $ to pay a NH bill is a real misnomer imo. The bridge loan I think of offhand is the 200M Popeyes Fried Chix got from Merril Lynch to use as operating capital while they were waiting for double that for financing from a Canadian bank for Popeyes to buy Church’s Fried Chix. Popeyes needed bridge to pay off Churches shareholders and run both systems initially. Pretty bold & spicy move at the time & it actually got called Merrill Lynch Chicken in the financial community (I’m in New Orléans). Bridge loans can also get done like when your buying a new house but still waiting to get your old house sold and you dont have the $$$ to buy new house and will loose the new house if you cannot close on sellers timetable, so you get interim “bridge” $$$ to totally buy new house and then pay off bridge once old place sells. The old house is placed as collateral on the bridge loan. 

Bridge tight on terms with hefty interest and backed by collateral.

Like for Bunny’s situation, someone in the family with a job & assets gets a personal loan from a bank for the entire amount owed to AL to settle outstanding bill (bridges debt) and that family member then has to repay the debt. If they can’t then bank gets ugly with the collateral used to secure loan. Her mom can’t get a bridge or any type of loan as she’s not credit worthy as no collateral. 

Bunny, I can't agree more with those who recommend the Area Agency on Aging. They were most helpful at directing me on the steps to take and in what order in August 2017 when I had to hurriedly get my mother into a nursing home. The business manager at the LTC facility was also helpful. Your mother's LTC facility should have a licensed social worker who is there to help HER. At my mother's LTC facility the LSW was overworked and had no time to help me.
I couldn't have done it without AgingCare.com where I had been lurking and researching for over a year before I finally was forced by Mom's condition to act. I was armed with a wealth of information from this forum. Because of AgingCare.com and researching Ohio Revised Code I was able to draft a Miller Trust (QIT, Qualified Income Trust...for Medicaid eligibility), Durable Power of Attorney, Health Care Power of Attorney, Funeral Directive (Mom wanted to be cremated and without this document ALL SIX siblings would have to agree. I knew one of my five siblings would vehemently disagree and toss the entire thing into probate court upon her death), get everything signed by Mom and notarized in about seven days. I could then open two checking accounts (personal for Mom with me as POA, QIT account with me as Trustee), sell her house, pay off the mortgage, close out all her utilities and pay her final bills, change her mailing address to my address, liquidate her meager assets, talk with her Medigap insurer as her POA, pre-plan and pay for what she and I jokingly referred to as her ZipLock Baggie funeral, apply for Medicaid as her authorized representative (another paper she had to sign) and FINALLY hurry up and wait on Medicaid. I wouldn't recommend EVERYONE try to handle all the legal papers without an attorney but, although it seems daunting, they aren't as difficult as you might think. Your states codified legal code (legislation, regulation and executive orders) may actually have one or more of the necessary forms written word for word into the code which you can find online, copy into word processing software and personalize. Your state's Bar Association may also have downloadable forms to fill out. It didn't hurt that I'm pursuing a degree as a paralegal and thus had some helpful legal knowledge. I should also admit that I flunked the semester that I was taking care of Mom's needs. I made it to class and have the information in my brain but didn't have time to complete many of the assignments. Mom first!!
Medicaid was approved on December 29, 2017. The following day I held her hand as she peacefully passed into Eternity due to respiratory failure caused by COPD and complicated by congestive heart failure. She was surrounded by five of her six children, thirteen of her twenty-one grandchildren and one of her four great-grandchildren.
I'm thankful that I was able to take a load off of her in her final days. Come next fall it's back to college to take the classes I failed once more. I hope I've helped someone.
Cheerio!
Cindy

Can you please clarify if it is assistted living facility or a nursing home because you are saying both and the financial services would be entirely different

Bunny, sounds like you are trying to clean up someone else's mistakes. Going higher might work - many times the lower level people do not have authority to do much.

Is this the payment for the waiting period before the LTC payments started? How long was the waiting period? Who signed the contract with the ALF. Did they not understand the terms of the LTC policy, and that it would be private pay until the LTC policy kicked in?

My mother's LTC policy requires a 30-day waiting period. So if she were to go to a facility, payment for the first month of that facility would be out-of-pocket.

Bunny,
Was your LTC Policy one that did not start the instant you needed it but maybe 90 days later?

JoAnn
It was on bunny’s profile that her mom is in ALF.

BUNNY
Was there a misunderstanding about when the LTC would begin?
I’m not familiar with the bridge loan. You can go to the search box for this website and enter that term and see what comes up. However, the word loan indicates repayment.
Ask the ALF about how the county assistance is accessed. Perhaps you could call Area Agency on Aging and discuss this problem.
When the ALF can’t squeeze blood from a turnip they might agree that the SS payment and the LTC payments add up to more than the county assistance provides. The problem might be that the person you are dealing with does not have the authority to do anything but push for payment. See if you can elevate your level of contact. Ask if there is someone else you can speak with that might have the authority to evaluate your moms situation. Explain they are leaving you with little recourse but to move your mom as mom is already giving them all she has.
Surely this has happened before...that the LTC didn’t kick in.
Have you exhausted all negotiations with the LTC?
Perhaps another poster will have experience with getting LTC to pay retroactively??
I’m not personally familiar with any of this, just trying to help you think through your options.
I would probably get am elder attorney familiar with LTC and Medicaid to look the contract over.

JoAnn29. Thank you for the feedback. This was all new to me. Some people are not as adept at taking care of two sets of finances. The decision on the facility was not really mine-I am just trying to work with what I have at this point and move forward. So yes, to your point I may need to move her...Which will come with an entirely new set of circumstances.

The ALF said that most of the people there are on county assistance. Would that be medicaid?? Does anyone know?

I am confused, I see nothing that says this is an AL? If it is, weren't you aware of Moms finances and how much you had to work with? Or, has the cost of Moms care gone up meaning she needs more care? At Moms AL I was informed increases would be made each January and if she needed more care her care cost would go up. I am assuming that Mom is using her SS and a pension for her care? She has no extra assets? If this is an AL you may have to move her to a NH that excepts Medicaid. The balance to the AL will need to be paid. Really need more info.

We got behind due to the lapse in coverage-her LTC did not kick in right away.

All of her expenses have been trimmed. We do have POA and she has been formally diagnose with dementia and very limited capacity. Her SS and LTC cover the monthly payment. So there is nothing left to pay the past due balance. We may need to find a different care facility that is more affordable?? But it will be hard for her to make that move(physically). I hope I don't sound like I am not open to your suggestions! I am very much so. I am feeling hopeless. We are unable to contribute to these costs. I saw something about a bridge loan??Does anyone have any thoughts on that?

The payment schedule that they have us on is not manageable. They are really pushing for this lump sum payment. I will try to contact the Ombudsman..
They have been working with us and it's as if we are not paying down the balance fast enough..I appreciate all of the suggestions!

If she doesn’t pay for her housing she will have to move.
Let’s start from the beginning.
Does your mom have capacity to make her own decisions?
Does she have the income to pay bills but has lost the desire to be responsible?
Does she drive? Does she have credit cards?
If she is in over her head with debt then that is one problem. If she doesnt have adequate income that’s another issue.
If she has not been evaluated by a neurologist to establish competence she needs to be since you indicate that she has dementia.
Do you have the authority to act for her via a DPOA?
The worst thing you can do is subsidize her income without getting all your ducks in a row.
The AlF must be paid or a cheaper one found. Her car and insurance etc might need to be eliminated or whatever expenses she has that can help her get caught up.
Give us more information so we can better help you.
EDIT
I just saw you gave more info. 
Medicaid does not cover ALF that I am aware of. 
But a visit to a certified elder attorney might help. 
You say she has no assets, does she have income? Has her income changed since she moved in? Has the price gone up? 
I’m trying to understand where it went wrong. When she got behind and why? 

Can you meet with the financial department at the ALF and ask for a payment schedule that you and your mother could handle?

Get the ombudsman involved. Their number should be posted in the facility, or ask them for it.

They try to settle disputes.

She has no assets. She can apply for Medicaid-but that doesn't address the past due balance. I am having some very real anxiety over this...

can she apply for Medicaid? Does the facility accept Medicaid? Are there any other assets she could sell to address the balance?