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I would not be worried about $ part of PACE. If she is a “dual” so already on MediCARE & Medicaid, PACE uses those for health care costs. However, she probably will be asked to file for community based Medicaid as well as that Medicaid program usually is part of PACE umbrella as to how costs are covered for the custodial type of costs. That program does have its requirement for State to have to attempt to to a recovery of all costs paid via MERP aka estate recovery, after death, BUT, since this is FL, your mom can see an attorney to look to possibility of getting Lady Bird Deed done as FL is one of few States that allow for these. This is something I’d suggest in my not an attorney musing’s that you find out clearly about b4 anything done should your mom want to safeguard her home.
But what I’d be way way more worried about with PACE is her health care providers…. I don’t know how the FL PACE runs but we have one by us in New Orleans, the Benson Center. ((I did a lengthy post on it last week as we had a flurry of PACE ?’s last week on this site which I’m guessing means CMS (Centers for Medicare & Medicaid) aka the Feds are encouraging & diverting $$$ to PACE so centers are casting their nets about for enrollment.)) The Benson PACE, like all others in Louisiana, have it set up that once you get assessed to be eligible for PACE, the PACE then becomes your hub for all health care. I think it’s tied into Tulane/LSU for their health science center, so if your doctors were Oschner Foundation or East Jefferson Health System, it would means adios to all those doctors and those relationships completely. PACE becomes similar to a managed care system in that the PACE will have a health science center / network that they interact with EXCLUSIVELY! It will be totally “in network” for care. PACE schedules all appointments needed and does all the billing too. PACE becomes her “insurance”. So if your mom need to see an eye doc, the PACE will schedule it and their van will take her and an aide from the center will accompany her to the appointment, that’s how the system runs (if family wants to take their elder they can but has to be MD the PaCE schedules). This may be an issue for your mom as it sounds like her doctors are finally ones that understand her health issues?? If she sees anyone outside of PACE network, it will be out of network and seriously $, & a mess for billing as no insurance coverage. Don’t even think about taking her for a out of State visit or visit to another part of the State as her PACE health insurance really isn’t portable as she’s kinda viewed as being “NH ready” so should not be out gallivanting.
PACE will likely have part time MD, full time RNs & NPs & PAs, SW, therapists of all types, some have X-ray & lab if not on premises then a van that comes around on schedule. Center is more than just a day care activities center with hot meals served but more that plus a small scale clinic as well and a PT/OT sector that can bill Medicare those “gait training” billable hours (to keep muscle tone & keep from muscle waste). Folks go to center 2-4 days via provided transpo & tend to leave with a meal for dinner. center designed for those at-need of NH level of care but can continue to safely live in the community with care & support of others of which the PACE provides 2-4 days of but on family or others to do rest of the time. Some PACE augment in-home wkend care 3-5 hours. Plus meals on wheels for non PACE weekdays. It’s family for all the rest of the time.
Realize # of hours notated in initial assessment. If # too high, mom may be too high of a level of care & oversight for a PACE. She may actually need 24/7 oversight of a NH/skilled nursing facility. Really you need to do a onsight visit and review the application in detail.
Is this a part of why you are hoping PACE could work as you really don’t want her going back to the Nh and having her do that copay to the NH as it would cause her to have to sell her home (as she could not longer afford it due to the Medicaid copay of her SSDI income to the NH)? I totally understand this whole line of reasoning.
If she’s still pretty young, really go to the PACE and do a couple of day visits on your own. If they are overwhelmingly 80-90 yrs old there, they will not be a good fit for your mom. But perhaps one of the staffers at the PACE (like PT or OT) may know of a day program that geared for stroke or maybe TBI rehab for a younger person that she could enroll in. Smaller and more intense that will bill “dual”. Good,luck and let us know how this works out.
Mom turns 75 this year. She was on SSDI before her hemorrhagic stroke. We're looking into the PACE Place because she truly wants to die at home and never be in a nursing home again.
At this point she really needs constant supervision and it is exhausting. We feel if she can go even 1 or 2 days a week and they handle all the scheduling and transportation for doctors visits, it could really provide a much-needed reprieve for us while giving her an opportunity to enjoy getting out of the house and having some of the social interaction she so desperately needs.
Mom already has a reverse mortgage on her home she took out 12 years ago and that interest is piling up every month. I doubt if there will be anything for the state to collect after that is satisfied. (BTW, we will lose the house 4 generations of our family have lived in because she took out a reverse mortgage to put on a roof, put insulation in the house, and do plumbing and electrical upgrades. In 12 years her balance has more than doubled, almost tripled, and just keeps going up every month. Stay away from reverse mortgages. They are evil.)
I think our local PACE is connected to UNF's medical program, and they cared for her after her hemorrhagic stroke and some other issues she has had, she has always been comfortable with their services.
And no, she's not out gallivanting at all. It's like pulling teeth to get her out of her hospital bed, which is why we think the social interaction may help her tremendously.
We will certainly look at the # of hours noted in the initial assessment - that's a great pointer you provided. I don't know what we will do if/when she requires a NH/skilled nursing facility. We will address that battle when it surfaces I suppose.
Thank you, igloo572 for sharing your insights. You've really helped us out a lot here.
FwIw for PACE in my area it seems to now be 1 of 2 clear paths to get a LTC Medicaid bed in a SNF/NH: it’s either they are PACE assessed to be “NH ready” so paperwork is all done but still safely in the community enrolled in the PaCE with family or other congregate living staff filling in all the rest of time (all “duals”)
OR
they get hospitalized (like they fall and break something) and then are discharged to rehabilitation at a SNF (all of this Medicare benefits) and then segueway from rehab patient (MediCARE) to LTC custodial care resident (Medicaid). They have a huge fat medical file so it’s all there to pass a “at need” medical review.
Nowadays to come into a NH off the street, so to speak, and file for LTC Medicaid flat is not done anymore in my state (Louisiana). I did this for mom in TX. When I got her into a NH, she went from IL to NH, bypassing AL phase & any hospitalization; & absolutely no way this would ever fly now; looking back I’m surprised it did work but that’s the advantage of not knowing & doggedness.
I hope you stay on this site and give your occasional take on Reverse Mortgage questions. It would be helpful to have someone who has a clear eyed view & experience on the process. Best of luck and patience with your mom. Hope all this gets sorted out b4 storm season.