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  1. #1
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    Nursing Homes - Where to begin

    My mom pretty much is no longer to care for herself after lengthy hospitalizations since early this summer. She lives alone and her gentleman friend who is up in years helps her out quite a bit as she can no longer (or doesn't want to) drive and is on permanent dialysis 3 times a week. She is very weak and she told me today that she woke up on her bedroom floor early this morning and could not stand up and had to crawl to the phone to call her friend to assist her.

    She indicated to me that maybe she should live in a nursing home for "three months" until she got better, and she also said maybe it would have been better if she had died because of all the pain and suffering she's been going through.

    So it's up to me and my brother who are her only living relatives nearby. Brother does absolutely nothing for her even though he lives 3 minutes away from her.

    How do I get the ball rolling for nursing care homes? Who do I call. Her home is titled to both herself and my brother and titled that if one of them goes first, it goes to the other (kind of like husband and wife). But here's the thing. About 18 years ago she Quit Claim Deeded her half to all three of her children. So in effect, one-sixth supposedly goes to me.

    The reason I bring all this up is, I know Medicare allows you to stay in nursing home for 3 months, but then you have to sell your property or something to pay Medicare or the nursing home. How would this work in her situation? Her car is in her son's name. She has no money in the bank, no life insurance.

    WIll this hurt her when I look for a nursing home for her? This is a bad situation. She cannot live with me as I work full-time and she needs transportation to and from dialysis 3 times a week.

    Sorry for the long post and thanks for any suggestions.

  2. #2

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    Does your town have an Elder Services department? They can help you navigate choices including the Medicare/Medicaid issues. You will need someone to figure out how much of the house she actually owns as she may immediately qualify for state Medicaid if she really has forfeited her ownership rights. Medicaid will complicate nursing home choice, as the reimbursement is quite low.

    Long story short, first thing is to figure out what she qualifies for, then research nursing homes that will accept reimbursement under her program.

    eta, there are special rules for patients with ESRD. Again, Elder Services is a good starting point.
    AceOn6, the golf loving skating fan

  3. #3

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    I may be wrong about this, but I don't believe Medicare covers nursing homes (they cover medical care received at a nursing home, at the same rates they cover doctor's visits, but I don't think they pay for the actual housing fees). I believe Medicare covers rehab care - in a rehab facility - for those just out of the hospital, but I'm not sure your mother would qualify for that b/c it sounds like she's been out of the hospital for a while. Check with her doctor or the social worker at the hospital.

    For an actual nursing home, if your mother has no assets, she would probably qualify for Medicaid. Make appointments to view several nursing homes in your area (perhaps your mother's doctor has recommendations) and be sure to meet with their finance person and they can explain the process to you and probably answer your questions about the house issue.

    Not all nursing homes accept Medicaid, but most do. Be sure to ask before you go look. As long as they accept Medicaid, it is illegal for them to discriminate on any basis, including financial.

    Try to choose a home that will take care of the paperwork for you, as opposed to sending you to some gov't office and handle everything yourself. When they submit your paperwork, they will ask for all necessary documents.

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    She had been in a couple nursing homes for a short while this summer following hospitalizations for physical therapy. She was last discharged about a week ago after a two-week hospital stay. She has become progressively weaker, so maybe if I call her doctor or the social worker at the last hospital they can tell me if she's eligible for nursing home care. I think that would be a good idea at least as far as physical therapy. She can't even unscrew lids and now has a hard time walking around. Some exercise might help.

    Also, she has some other complications such as she's a liver transplant patient for many years, that coupled with the thrice weekly dialysis, her age (almost 70), and she's a bit illiterate all work against her.

  5. #5
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    Her doctor might offer suggestions. I don't know where you live. Do you have an Area Agency on Aging in your area? Our Cleveland link is here

    http://www.psa10a.org/default.asp.


    http://www.psa10a.org/Programs/preadreview.asp
    They have publications and information in their resource guide about nursing homes and about Medicare and Medicaid coverage.
    Last edited by mmscfdcsu; 12-22-2010 at 08:33 PM.

  6. #6

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    It sounds as though she might qualify for a number of services - medical and practical.
    Does her dialysis center; or the facility that she was recently discharged from, have a social worker that could help you determine what would be best - and how to achieve it?

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    I agree with mmmmmary. Check to see if there are any resources to help you through an office of aging department. Make sure that you know what the property deeds/who owns what etc. Especially if your brother is not interested in assisting in this matter.
    It is really hard to have to take these steps. But your mom recognizing that she is unable to continue to stay at home is a point in your favor, making it easier to do. Although she has said for three months, I suspect she knows that she is unable to return home.

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    Have you checked with your local hospice? Since she has end stage disease, she may qualify for home hospice care, which could include nursing services, home health aides, housekeeping services, therapy- all kinds of services. Some people think hospice is only for those who are dying, but that's not the case. As long as someone has a progressively worsening disease they may qualify. My dad had hospice services for two years and I really think it saved my Mom's sanity, since she was trying to do everything for him. And the best part is that all hospice services are free. They are the BEST organization- please check them out!

  9. #9

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    Your mother's doctor (or a local hospital) may be able to give you referrals to agencies (everything from elder services to hospice to potential nursing homes) that can help.

  10. #10
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    I am assuming you are US since you refer to Medicare.

    There is a Medicare site for nursing home information:

    http://www.medicare.gov/nursing/overview.asp

    Medicare generally pays for some nursing home costs if you are referred to a skilled nursing facility right after a qualifying hospital stay. I don't know whether there can be a gap of time at home.

    There is also a concept called "spend down to Medicaid" but eligibility depends on the standards set by the state. If she has no assets, she might qualify for Medicaid, but you have to go to a certified facility. Depending on where you live, it can be a challenge to find space in a certified facility. I once called around looking for a spot for a friend of mine who was dying of lung cancer - I must have called 40 places before I found one with a bed that would accept Medicaid. But I got a list from a local hospice -- sometimes people recover a little so they are no longer hospice candidates and have to be referred to a nursing home.

    There is an overview on this at this link.
    http://www.medicare.gov/Nursing/Payment.asp

    Alternatives to Nursing homes: http://www.medicare.gov/nursing/overview.asp
    I think I will have a snack and take a nap before I eat and go to sleep.

  11. #11
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    Google the nursing homes in your area and read the reviewsand health inspection reports. However, take the reviews with a grain of salt. The inspection reports are a good guide, BUT read them throughlly, sometimes a nursing home in dinged for the little thing. My best advice is to visit 2 or 3 homes in your area, talk to the social services director and observe the staff in doing the residents' care and attitude towards the residents.

    I hope this helps.

    Carol

  12. #12
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    Your local health department will also have some information about area nursing homes, as well as some information regarding eligibility for Medicare and Medicaid. They are also aware of the facilities with and without waiting lists.

  13. #13
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    Quote Originally Posted by Rob View Post
    I am assuming you are US since you refer to Medicare.

    There is a Medicare site for nursing home information:

    http://www.medicare.gov/nursing/overview.asp

    Medicare generally pays for some nursing home costs if you are referred to a skilled nursing facility right after a qualifying hospital stay. I don't know whether there can be a gap of time at home.

    There is also a concept called "spend down to Medicaid" but eligibility depends on the standards set by the state. If she has no assets, she might qualify for Medicaid, but you have to go to a certified facility. Depending on where you live, it can be a challenge to find space in a certified facility. I once called around looking for a spot for a friend of mine who was dying of lung cancer - I must have called 40 places before I found one with a bed that would accept Medicaid. But I got a list from a local hospice -- sometimes people recover a little so they are no longer hospice candidates and have to be referred to a nursing home.

    There is an overview on this at this link.
    http://www.medicare.gov/Nursing/Payment.asp

    Alternatives to Nursing homes: http://www.medicare.gov/nursing/overview.asp
    I was reading this thread and was going to comment similar to the above. When my dad had cancer and chemo, he would end up in the hospital overnight every couple weeks to be rehydrated. I thought it really could not go on like that. (He was o.k. living by himself, with me running over there all the time, and his brother-in-law drove him to chemo.) We needed for him to stay in the Medbridge/rehab, but he had to spend 3 nights in the hospital first. The doctor in the hospital in charge of his care "made up" a possible infection to keep him in an extra night and he went to the nursing home cancer rehab the next day.

    It was "skilled" care and Medicare paid for it. Once he was no longer "skilled" or able to make any more progress, they pretty much forced me to put him in the assisted living, which was not paid for by Medicare. Three years ago it was ~$240/month. He had plenty of savings (and was still receiving SS and pension which was as much as I was making working!), but I was prepared to sell his house or my house if I had to to keep him there as long as possible.

    (Terrible thing for me to think and talk about at Christmas), but he went into assisted living on a Friday, barely made it to the oncologist (the nursing home transport took us there and back), on Monday and went directly back into the hospital, and passed away there the next Friday.) I think the move to assisted living and the less comfortable bed and things did him in. I know - it was just a matter of time. It just always bugged me that as much as he complained about the nurses and stuff in rehab, at least he didn't get worse there.

    Sorry I wasn't any help. Just thought I'd share. I have to go think about something else now.................

  14. #14
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    Good grief - as soon as I hit post, I saw out of the corner of my eye - I meant $2400/month, not $240!!!!! Can I use the excuse that my hands have been freezing all day?

  15. #15

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    Cupid -- It might be worthwhile to locate a geriatric care manager in your area who can evaluate your mom and then help you sort through the available resources in your mother's area. We paid about $250 for a consult, and it was well, well worth it. She knew of far more resources than I knew of, knew how to get the ball rolling, and helped us figure out how my mil could more safely continue to live at home, which is what my mil wanted to do. Here is the site we used to find one:
    http://www.caremanager.org/

    It can really be some tough decisions and challenging problems. If she happens to be certified as terminally ill (and I don't know that she is or isn't) hospice can be a tremendously valuable resource -- but check out the references on at least a couple hospices in your area.

    The holidays can be an especially challenging time for trying to cope with this -- sending good thoughts....

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