Doctor says my mom should be in an assisted living facility but we can't afford it

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ResearchMed
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by ResearchMed »

ralphboy wrote: Thu May 18, 2023 11:02 am I'll call the local Council on Aging. I'm trying right now to get a gameplan and figure everything out.

It would probably be helpful if you contact at least one of these agencies before you "figure everything out".
What you learn from them could greatly affext your planning.

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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by biscuits »

ralphboy wrote: Wed May 17, 2023 9:53 pm She fell again when she returned home and when she visited her doctor for an evaluation her blood pressure was 200/100 (She forgot to take her meds the few days she returned home).
As several posters have said, the hospital, nursing home, or rehab center where your mom was being treated should not have discharged her directly to her home with no support. As an example of the services available in this situation, should it arise again: my late husband was hospitalised with a mobility and cognition crisis and before he was discharged, a hospital social worker came to his room, interviewed us in detail about the layout at our home and the amount of care I could provide. She had orders for home health care, and presented me with a list of agencies from which to select a provider. I selected a highly-regarded agency; she made all the arrangements and filed all the paperwork. The agency called me and set up an appointment for a nurse to come to our home the next day and evaluate my husband and our home situation and develop a treatment plan. The nurse came, spent about an hour with us, and recommended physical therapy at home twice a week, occupational therapy at home twice a week, and speech therapy at home twice a week. We could have asked for home health aides for bathing and other tasks of daily living, but at that point they were not necessary. The recommended therapists came and were terrific. Medicare paid for all of this. Medicare required periodic re-authorization, but the services continued for 5 months (until my husband's condition had declined to the point that he needed full-time care. And this is not applicable to OP's situation, but at the end of 5 months, when I filed a claim on his LTC insurance, the 90-day exclusion requirement of his LTC policy was met by the time he received these Medicare-provided services. That was a surprise.)
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

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Silentnight wrote: Wed May 17, 2023 10:32 pm https://www.flmedicaidmanagedcare.com/h ... ealthplans
In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. People on Medicaid will get services using one or more of these plan types:

• Managed Medical Assistance (MMA): Provides Medicaid covered medical services like doctor visits, hospital care, prescribed drugs, mental health care, and transportation to these services. Most people on Medicaid will receive their care from a plan that covers MMA services.

• Long-Term Care (LTC): Provides Medicaid LTC services like care in a nursing facility, assisted living, or at home. To get LTC you must be at least 18 years old and meet nursing home level of care (or meet hospital level of care if you have Cystic Fibrosis).

For which health plan services are you eligible?
Please enter your zip code or select your county of residence:


https://www.medicaidplanningassistance. ... y-florida/
Medicaid is a health care program for low-income individuals of any age. While there are various coverage groups, this page is focused on long-term care Medicaid eligibility for Florida senior residents (aged 65 and over). In addition to care services in nursing homes, adult family care homes (adult foster care homes), and assisted living facilities, FL Medicaid pays for non-medical services and supports to help frail seniors remain living in their homes. There are three categories of Medicaid long-term care programs for which FL seniors may be eligible.

1) Institutional / Nursing Home Medicaid – This is an entitlement program; anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.

2) Medicaid Waiver / Home and Community Based Services (HCBS) – These services are not an entitlement; the number of persons who can receive these services is limited and waiting lists for some services may exist. Intended to delay nursing home admissions, long-term care benefits are provided at home, adult day care, in adult foster care homes, and in assisted living residences via a managed care system. (snip)

.....The three categories of Medicaid long-term care programs have varying financial and medical eligibility criteria. Financial requirements change annually, vary based on marital status, and is further complicated by the fact that Florida offers alternative pathways toward eligibility.

...The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long-term care from a Florida Medicaid program. Alternatively, one may take the Medicaid Eligibility Test. IMPORTANT: Not meeting all the criteria does not mean one is ineligible or cannot become eligible for Medicaid in Florida. More.

https://www.medicaidplanningassistance. ... -smmc-ltc/
Florida’s Statewide Medicaid Managed Care (SMMC) Long-Term Care (LTC) Waiver Program provides a variety of long-term care services and supports for Florida residents who are elderly or disabled and require a Nursing Home Level of Care. While nursing home care is a benefit available via this program, a variety of home and community-based services (HCBS) are also available to program beneficiaries in their home, the home of a loved one, an adult family care home, or an assisted living residence to prevent and delay the need for institutionalization (nursing home admission).......


These 3 sites should help you get started on your research.

Good overview of whats available.

Humana,UHC and most MA plans are good at sniffing which members qualifies for medicaid and will reach out to members and help them apply so she may very well already have a medicare savings program( medicaid).Easy way to find out is call Fl medicaid 866-762-2237 and after listening to a long message you can enter her social and dob and it will tell you on the automated calll if she has a medicare savings prorgam.food stamps etc. Then call Fl elder source 800-963-5337 to schedule an assessment for Waiver program. If she doesn't already have medicaid they will help with that but i recommend you start the medicare savings program application asap so the state will pay for her medicare part B premium,co insurance and deductibles. apply at https://www.myflorida.com/accessflorida/ This would also make her eligible for a Medicare Advantage Special Needs Plans for Dual Eligibles ( medicare and medicaid) that also pays for additional things like up to 280.00 per month for food,otc products,utilities,free emergency response monitoring,dental,eyeglasses,transportation etc.If she has to be in nursing home all Medicaid approved nursing homes will complete the application for Institutional Medicaid for you.

I have helped hundreds of people apply for a medicare savings program in Fl and typically it takes anywhere from 10 -30 days to get approved .The process of getting approved for a Waiver program can take months but the waiting list could be years.

https://training.floridashine.org/Websi ... 0CHART.pdf

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ralphboy
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by ralphboy »

This might be a stupid question but how do I get to the form to apply for medicaid? I tried medicaid.gov and apply for medicaid and each time I click a link, hundreds of other links pop up. It's like trying to find the holy grail.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

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You need to go to the Florida page listed above. Here’s the link again: https://www.myflorida.com/accessflorida/. Create an account for your mom, then submit the application
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ralphboy
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by ralphboy »

Thanks, should I go ahead and take money out of my mom's account to get her savings to only $2,000?
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by bluebolt »

ralphboy wrote: Sat May 20, 2023 8:53 am Thanks, should I go ahead and take money out of my mom's account to get her savings to only $2,000?
I think that's probably not the best idea. As others have said, you need to talk to a professional who knows about this and get their advice.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by cheese_breath »

ralphboy wrote: Sat May 20, 2023 8:41 am This might be a stupid question but how do I get to the form to apply for medicaid? I tried medicaid.gov and apply for medicaid and each time I click a link, hundreds of other links pop up. It's like trying to find the holy grail.
You should not do that by yourself. It's complicated. Do it wrong, and you might have to wait months before you can submit another one. You need a professional such as an elder law attorney.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by stan1 »

ralphboy wrote: Sat May 20, 2023 8:41 am This might be a stupid question but how do I get to the form to apply for medicaid? I tried medicaid.gov and apply for medicaid and each time I click a link, hundreds of other links pop up. It's like trying to find the holy grail.
ralphboy wrote: Sat May 20, 2023 8:53 am Thanks, should I go ahead and take money out of my mom's account to get her savings to only $2,000?
You have gotten great advice on this thread. Please, please follow it!
There are plenty of resources available to assist, you don't need to do this alone.

Medicaid varies by state and can be complex. That's why there are so many resources available to help.
Call your local council on aging as many others have said. I'm not sure why you don't want to do that, but it is a mistake to try to do this yourself.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by Silentnight »

ralphboy wrote: Sat May 20, 2023 8:53 am Thanks, should I go ahead and take money out of my mom's account to get her savings to only $2,000?
Don't do that until you have spoken with a Medicaid caseworker and thoroughly understand the eligibility requirements. Medicaid can severely frown on people who deplete their assets in order to make themselves eligible. From Medicaid's point of view, Medicaid is similar to the "last resort" and Medicaid views it as "you need to help yourself first" b/f relying on them. If you take money out of her account the wrong way, there could be bad repercussions. They can look at is a "cheating" if you don't do everything to help yourself first. Talk to the experts b/f you do anything. (Using her money to pay her bills is not transferring money--that would be helping yourself first)

I'm not recommending you see an elder attorney, but this site gives you some info about transferring resources. https://www.dhclaw.com/blog/calculating ... enalty.cfm
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by quantAndHold »

ralphboy wrote: Sat May 20, 2023 8:53 am Thanks, should I go ahead and take money out of my mom's account to get her savings to only $2,000?
Also, if you take money out of her account and don’t use it to benefit her, it could be construed as financial elder abuse.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by cheese_breath »

ResearchMed wrote: Thu May 18, 2023 9:53 pm ...It would probably be helpful if you contact at least one of these agencies before you "figure everything out".
What you learn from them could greatly affext your planning...
You need to contact at least one of these agencies before you do anything. You're getting some good advice here. But you need to sit down with someone who can discuss the whole picture together with you, rather than bits and pieces as we respond to your questions.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by cashmoney »

Shackleton wrote: Thu May 18, 2023 8:26 am First off, you’re doing a good job trying to figure this out. It is overwhelming. I’m not 100% certain since it varies by state, but my understanding is that Medicaid would replace Medicare and her Humana Gold plan. But I really suggest you read the links posted by Silentnight above (viewtopic.php?p=7272473#p7272473)

Also, the “case worker” at the doctor office is probably not a trained “social worker” which is what you need. The case worker may just be the billing person assigned to your moms account at the doctors office. Again, start by rereading and looking at the three links posted by Silentnight above.
In Fl and i believe this is how it works in most states if someone is already enrolled in an MA plan and later gets approved for a medicare savings program ( medicaid) they remain on the MA plan and copayments of MA plan can be billed to Fl medicaid but this is not ideal. In this case if person has full medicaid or QMB level medicare savings program and wants to remain on a MA plan it is better for the person to switch to a Dual Special Needs MA Plan (DSNP) that is designed to be seamless with Medicaid or they could revert back to original Medicare and choose one of the Managed Medical Assistance( MMA) they want as secondary to Medicare

If person is on original medicare and later gets approved for medicaid they will be given the choice of which state Managed Medical Assistance( MMA) they want to enroll in as secondary to medicaid. This varies by county but the big players in Fl are UHC,Humana and Sunshine .If a person doesn
t make a choice they will be randomly auto enrolled in one of the MMA plans

Since your mom lives in HUD housing whatever her HUD housing subsidy is will probably count as income when qualifying for a medicare savings program but this wouldn't matter if she is applying for Institutional Medicaid. Usually if someone has applied for HUD housing the person helping them apply would have also looked in to applying for a medicare savings program but is not unusual for a HUD housing subsidy to disqualify a low income person for a medicare savings program. If her HUD apartments has a social service coordinator one of their main functions is to help residents with filling out these forms.


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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

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ralphboy wrote: Sat May 20, 2023 8:53 am Thanks, should I go ahead and take money out of my mom's account to get her savings to only $2,000?
no, but you could use excess resources above $2000 on an irrevocable burial reserve to spend down assets. Because it's irrevocable, she can't get the money back and the monies in the burial are excluded in countable resources. This is assuming she hasn't already prepaid for her funeral expenses.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

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https://www.amazon.com/dp/B08YGKCHNF
Look into Amazon Echo Show.
It allows drop-in feature which doesn't require your mother to click any button. This way, you can do video with her and check-in on from your mobile several times a day.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by quantAndHold »

arcticpineapplecorp. wrote: Sat May 20, 2023 12:45 pm
ralphboy wrote: Sat May 20, 2023 8:53 am Thanks, should I go ahead and take money out of my mom's account to get her savings to only $2,000?
no, but you could use excess resources above $2000 on an irrevocable burial reserve to spend down assets. Because it's irrevocable, she can't get the money back and the monies in the burial are excluded in countable resources. This is assuming she hasn't already prepaid for her funeral expenses.
You can also use the money to pay for in-home nursing care for her while you’re getting this all sorted out.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by clip651 »

quantAndHold wrote: Sat May 20, 2023 2:51 pm
arcticpineapplecorp. wrote: Sat May 20, 2023 12:45 pm
ralphboy wrote: Sat May 20, 2023 8:53 am Thanks, should I go ahead and take money out of my mom's account to get her savings to only $2,000?
no, but you could use excess resources above $2000 on an irrevocable burial reserve to spend down assets. Because it's irrevocable, she can't get the money back and the monies in the burial are excluded in countable resources. This is assuming she hasn't already prepaid for her funeral expenses.
You can also use the money to pay for in-home nursing care for her while you’re getting this all sorted out.
I would really hesitate to work on spending money down without a comprehensive plan. Mom doesn't have many financial resources, which means she doesn't have many options and she has a lot of needs. It may take a while to get things organized for her, there may be waiting lists, etc, etc.

There are likely many ways to legitimately spend things down once it is determined what she needs, what the restrictions are, what she qualifies for, or will qualify for in the future, what sort of help various services will provide, etc.

ralphboy, have her save her money for the moment, aside from spending on what she needs right away. You are getting all sorts of advice on this thread. People are trying to help. But none of us have her full picture. Most of us don't know her local resources in detail. You need to get some real, in depth, targeted and local advice to make a plan. If you aren't sure where to start after the discussion here, start with an experienced social worker who is used to working with medically needy elderly without a lot of financial resources. The social worker can help you understand the local resources and programs, etc. The facility your mom was discharged from, and/or her primary doctor should hopefully be able to make a referral for a good social worker.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

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quantAndHold wrote: Sat May 20, 2023 2:51 pm
arcticpineapplecorp. wrote: Sat May 20, 2023 12:45 pm
ralphboy wrote: Sat May 20, 2023 8:53 am Thanks, should I go ahead and take money out of my mom's account to get her savings to only $2,000?
no, but you could use excess resources above $2000 on an irrevocable burial reserve to spend down assets. Because it's irrevocable, she can't get the money back and the monies in the burial are excluded in countable resources. This is assuming she hasn't already prepaid for her funeral expenses.
You can also use the money to pay for in-home nursing care for her while you’re getting this all sorted out.
that's true too. any medical bills and really any bills for your mom are fine since her coverage for in home care wouldn't start until resources were spent down anyway. So she could pay credit card bills, car payment, insurance, utilities, rent, but coverage wouldn't start until her resources were spent down to $2000 (and she can't give the money away to qualify, the money has to be spent on her).
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

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ralphboy wrote: Sat May 20, 2023 8:53 am Thanks, should I go ahead and take money out of my mom's account to get her savings to only $2,000?
From my experience, this is the worst thing you could do. I handled my MIL's Medicaid application and acceptance for the four years she was on it prior to her death. My wife and I handled her existing bills and her bank accounts. She exhausted her 145k retirement savings entirely while in her facility then transitioned immediately to Medicaid.

Social Services agents are people too, and they are constantly bombarded with dishonest petitioners who are trying to game the system. They can recognize all the tricks very quickly, and those who are honest are like a breath of fresh air to them. My advice is not to hold anything back, don't try to hide assets, and follow their instructions implicitly. You will be rewarded with a faster approval for it. I received several compliments for honesty from the agents we dealt with, which helped grease the wheels of what can be a bureaucratic nightmare.

I would second the suggestion to hire an elder attorney who has strong recommendations. Make clear to them that they are not the family's attorney, but should only be concerned with your mother's welfare and in her interests. Lawyers are people too, and will work harder for your mother when they determine that you have no motive to profit from the arrangement.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by WolfgangPauli »

This is a long shot but were either your mother or father (I assume he is deceased as you have not discussed him) in the military? My parents are in their 90's and in LTC in Florida. While they can afford it (for now) there is still a lot of care you will need to provide and, believe me, you will have to check and follow up over and over again.

So, we took a shot and applied to the VA for care giving services. Initially we thought they would contribute to funding the LTC as it is clear my parents will run out of money (Due to longevity) but the VA actually provides a care giver to come in for 26 hours per week! The care giver does everything for them including just sitting and making small talk. It has been a God send for us.

Just an idea in case it may work for you.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

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WolfgangPauli wrote: Sun May 21, 2023 7:21 am This is a long shot but were either your mother or father (I assume he is deceased as you have not discussed him) in the military? My parents are in their 90's and in LTC in Florida. While they can afford it (for now) there is still a lot of care you will need to provide and, believe me, you will have to check and follow up over and over again.

So, we took a shot and applied to the VA for care giving services. Initially we thought they would contribute to funding the LTC as it is clear my parents will run out of money (Due to longevity) but the VA actually provides a care giver to come in for 26 hours per week! The care giver does everything for them including just sitting and making small talk. It has been a God send for us.

Just an idea in case it may work for you.
My dad was in the Air Force. He's still alive. My parents are divorced.
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ralphboy
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by ralphboy »

I'm going to call the Area Agency on Aging of Pasco-Pinellas tomorrow. A person on reddit sent me this for medicaid help http://www.medicaid4youllc.com/
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

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I called the agency and they scheduled us a phone interview to assess my mom's needs. I also have a knowledgeable medicaid person calling me. My mom's savings is over the $3,000 limit because my brother and I loaned her money to help pay for dental surgery. Anyways, I feel a lot better now; thanks for all your help.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by cheese_breath »

Good to see you're making progress. Please keep us informed as things progress if you will.
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ralphboy
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by ralphboy »

Bad news, my mom fell off the bed and broke her ankle. She's in the hospital and will be getting surgery today (She was sent to a different hospital this time). She will then have to go to a rehab center again.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

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ralphboy wrote: Thu May 25, 2023 11:17 am Bad news, my mom fell off the bed and broke her ankle. She's in the hospital and will be getting surgery today (She was sent to a different hospital this time). She will then have to go to a rehab center again.
Sorry to hear, speaks to the urgency of getting things in place. Unfortunately, living alone isn't going to work.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by henry »

Sorry to hear that. Make sure to engage with the hospital social worker and/or case manager on your Mom's case. They will be focused on getting her to the rehab facility, but they may also be able to assist with navigating the process to qualify her for Medicaid and with your goal of eventually getting her to an assisted living facility. The rehab facility where she eventually goes should have a social worker and/or case manager that might be able to assist, but I would definitely discuss your concerns with the social worker/case manager on you Mom's case at the hospital as soon as possible.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by LilyFleur »

henry wrote: Thu May 25, 2023 11:30 am Sorry to hear that. Make sure to engage with the hospital social worker and/or case manager on your Mom's case. They will be focused on getting her to the rehab facility, but they may also be able to assist with navigating the process to qualify her for Medicaid and with your goal of eventually getting her to an assisted living facility. The rehab facility where she eventually goes should have a social worker and/or case manager that might be able to assist, but I would definitely discuss your concerns with the social worker/case manager on you Mom's case at the hospital as soon as possible.
I agree with henry. Hospital social workers can be very helpful. What happened to a member of my family was when the rehab facility asked him if he wanted home health care (which would have been covered by Medicare or insurance, I'm not sure which), he declined it. Once they decline that offer, they cannot change their mind. We then had to pay a home health care worker. I cannot stress this enough: do not let them discharge her without home health care.
Does your mom have a retinologist? Is she a candidate for laser therapy or the shots to help her vision?
You are doing the right thing, managing your mom's care. This is a season of life, and I know it's stressful for you, but it will not be forever.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by biscuits »

This is a tough cycle, but hang in there.

As others have said, connect with the hospital social worker and the social worker at the rehab facility. Medicare could cover up to several months of in-patient rehab if necessary, followed by several months of frequent home visits for Physical Therapy, Occupational Therapy and Home Care. You can use this time to research options for after that Medicare-covered care ends.

Rehab facilities have physical therapists and occupational therapists. The occupational therapists might be able help address the issues of your mother's low-vision as well as her mobility.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by clip651 »

ralphboy wrote: Thu May 25, 2023 11:17 am Bad news, my mom fell off the bed and broke her ankle. She's in the hospital and will be getting surgery today (She was sent to a different hospital this time). She will then have to go to a rehab center again.
Sorry to hear this. I agree with the others above to work with the hospital social worker to work on longer term planning for your mom.

I also agree, don't let them discharge her without proper plans in place (from the hospital, or later from rehab). When they start talking about discharge, if it seems to soon, or if plans are not in place, you can often appeal the discharge. This can allow extra time to get the plans in place, and it sort of forces the hospital or rehab to get the plans together. Usually on admission there is some paperwork in there explaining the rights to appeal discharge. If not, the social worker should be able to get you the info.

Also be sure your mom is giving appropriate HIPPA permissions for you (and your brother, too, even if he's not involved right now) to access her information, talk to her doctors and the social worker, etc. Assuming she wants your help, she needs to be sure the doctors and whatnot know they can talk to you. Again, the social worker can help if this paperwork isn't in place already.

Best wishes to you and your mom.

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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by LilyFleur »

Does your mother have an advance health care directive? What about healthcare power of attorney and financial power of attorney? If these things are not in place, it is probably time.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by cheese_breath »

LilyFleur wrote: Thu May 25, 2023 2:20 pm Does your mother have an advance health care directive? What about healthcare power of attorney and financial power of attorney? If these things are not in place, it is probably time.
And the HIPAA was already mentioned, but make sure of that too.
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ResearchMed
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by ResearchMed »

LilyFleur wrote: Thu May 25, 2023 11:54 am
henry wrote: Thu May 25, 2023 11:30 am Sorry to hear that. Make sure to engage with the hospital social worker and/or case manager on your Mom's case. They will be focused on getting her to the rehab facility, but they may also be able to assist with navigating the process to qualify her for Medicaid and with your goal of eventually getting her to an assisted living facility. The rehab facility where she eventually goes should have a social worker and/or case manager that might be able to assist, but I would definitely discuss your concerns with the social worker/case manager on you Mom's case at the hospital as soon as possible.
I agree with henry. Hospital social workers can be very helpful. What happened to a member of my family was when the rehab facility asked him if he wanted home health care (which would have been covered by Medicare or insurance, I'm not sure which), he declined it. Once they decline that offer, they cannot change their mind. We then had to pay a home health care worker. I cannot stress this enough: do not let them discharge her without home health care.
Does your mom have a retinologist? Is she a candidate for laser therapy or the shots to help her vision?
You are doing the right thing, managing your mom's care. This is a season of life, and I know it's stressful for you, but it will not be forever.
Please take the above advice VERY seriously: Home health care OR a residential facility.
STRESS that she IS NOT SAFE AT HOME.
Contact elder services NOW, so they are aware of the need.
(Please do NOT "wait to see how things go"; that's not the right approach for this type of situation. There is a LOT of work needed to find a safe place.)

And mumble something about how IF she's sent home and has another accident, that there could be some liability (and that is true). Don't be too heavy handed. Just let them know you are aware of the situation, etc.

I hope she recovers well!

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quantAndHold
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by quantAndHold »

I was on a jury once for a lawsuit very similar to this. Mom was discharged home, was injured. Was discharged home again, fell again. Eventually died of her injuries.

Emphasize to anyone who wants to discharge her home that she has already fallen multiple times, and been injured in a very short time after the last discharge, and she is not safe at home.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by InMyDreams »

clip651 wrote: Thu May 25, 2023 1:47 pm
ralphboy wrote: Thu May 25, 2023 11:17 am Bad news, my mom fell off the bed and broke her ankle. She's in the hospital and will be getting surgery today (She was sent to a different hospital this time). She will then have to go to a rehab center again.
I also agree, don't let them discharge her without proper plans in place (from the hospital, or later from rehab). When they start talking about discharge, if it seems to soon, or if plans are not in place, you can often appeal the discharge. This can allow extra time to get the plans in place, and it sort of forces the hospital or rehab to get the plans together. Usually on admission there is some paperwork in there explaining the rights to appeal discharge. If not, the social worker should be able to get you the info.
I mentioned in another post on this thread: you have the right to a review and appeal before discharge, whether that's from the hospital or from the rehab. As mentioned in that post - it sounds like your mother is in a MedAdvantage program. Be sure to follow the appeal process set up for MA programs. Senior Medicare Patrol may be able to help with that.
https://medicareadvocacy.org/expedited- ... al-rights/

Hospital discharge planning has probably already started. Connecting with the Social Worker/Discharge Planner is very important.

Best wishes to you and your mother.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by ralphboy »

LilyFleur wrote: Thu May 25, 2023 11:54 am Does your mom have a retinologist? Is she a candidate for laser therapy or the shots to help her vision?
She was seeing a retinologist. She had laser done once and many shots in each eye. She changed her primary care physician and she was against my mom getting the shots in her eyes. She asked my mom if they helped her and she said no and that her vision was getting worse; so we cancelled one of the shot appointments (She wouldn't have been able to go anyways). They take images of the back of my mom's eyes each time she goes for the shots, so I would assume they could tell if they are working or not. I don't understand why the primary care was against the injections.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by cheese_breath »

ralphboy wrote: Thu May 25, 2023 10:32 pm .... I don't understand why the primary care was against the injections.
I'm not intending to be hurtful in this time of you mother's injury, but you have got to become more proactive in managing her care. When a doctors do something you don't understand, ask them why. And don't stop asking until they explain it in terms you understand.
The surest way to know the future is when it becomes the past.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by TN_Boy »

cheese_breath wrote: Thu May 25, 2023 10:40 pm
ralphboy wrote: Thu May 25, 2023 10:32 pm .... I don't understand why the primary care was against the injections.
I'm not intending to be hurtful in this time of you mother's injury, but you have got to become more proactive in managing her care. When a doctors do something you don't understand, ask them why. And don't stop asking until they explain it in terms you understand.
Right, so very unfortunately, the OP is probably now in the situation where he needs to be managing mom's care the same as he manages (hopefully!) his own care. This is one of the things that happens when caretaking, even if you are not doing the hands on daily care. The patient is not really up to managing their own care. And the doctor offices are unlikely to coordinate in a useful manner. Thus .. you have to.

A few things.
  • If possible going with mom to doctor visits is useful. Take notes.
  • If mom is in the hospital catching her doctor during rounds is nice (often hard) and for complex issues, try and talk with the hospitalist.
  • Get logins for the various doctor office portals where you can send messages, ask questions, view test results, etc
  • Learn how to manage the interactions between specialists and the primary care. I found this challenging. You may need to request visits, etc
  • Of course have medical POA
  • Understand mom's medical coverage, and things like the medicare rules on appeals.
I also wanted to say you may want to work with the hospital on which rehab facility she goes to. It's possible their first choice is not your first choice. You ... may need to learn about the area rehab facilities, if there are options. Some are better than others, some are closer to you (can visit). You probably want to visit mom at rehab during a PT session to talk with the therapists and see how she is doing with your own eyes. A hour doing that is worth about 10 hours on the phone with people. You might also note issues that someone who doesn't know your mom might miss.

This can be very time consuming, I am sorry to say. And overwhelming. But it ... is what it is, and I found that buckling down and being organized about it ultimately saved me time and helped get better outcomes. Also, doctors and nurses are there to help and are on your side. But you and your mom are the "customer" and you care more about the outcome than they do. So be sure and ask direct clear questions until you get answers you can work with. This by the way is where the portals are useful .. you can ask questions and generally they will get back to you when they can.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by ralphboy »

I went through my mom's voicemails on her phone and found out that she had 2 calls from Humana (After her release from the rehab center). One from the "Humana Nurse Care Management team" and the other from a Nurse care manager. I called the manager and left a message. I'll explain to her what all has happened.
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ralphboy
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by ralphboy »

cheese_breath wrote: Thu May 25, 2023 10:40 pm
ralphboy wrote: Thu May 25, 2023 10:32 pm .... I don't understand why the primary care was against the injections.
I'm not intending to be hurtful in this time of you mother's injury, but you have got to become more proactive in managing her care. When a doctors do something you don't understand, ask them why. And don't stop asking until they explain it in terms you understand.
Yes, I should have done that. I asked my mom if she wanted to keep the appointment for the injection and she told me no. I feel like she doesn't have much desire to be alive (Her doctor sensed this as well and prescribed her an antidepressant).
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by TN_Boy »

ralphboy wrote: Fri May 26, 2023 10:27 am
cheese_breath wrote: Thu May 25, 2023 10:40 pm
ralphboy wrote: Thu May 25, 2023 10:32 pm .... I don't understand why the primary care was against the injections.
I'm not intending to be hurtful in this time of you mother's injury, but you have got to become more proactive in managing her care. When a doctors do something you don't understand, ask them why. And don't stop asking until they explain it in terms you understand.
Yes, I should have done that. I asked my mom if she wanted to keep the appointment for the injection and she told me no. I feel like she doesn't have much desire to be alive (Her doctor sensed this as well and prescribed her an antidepressant).
Giving medical advice is against forum rules, so I'll make no remark about a prescription being written for an anti-depressant in an elderly person without any other management of possible depression.

I can say that you probably want to understand the total list of your mom's prescriptions. You might find, as many of us have, that the list is amazingly long. I spent a lot of time trying to get relatives off medications that were no longer needed, inappropriate for their age (dosage required for a 30 year old versus a 70 year old) actually interacted badly with other medications, etc. The problem is specialist one writing a prescription for condition A, then specialist two writing a prescription for condition B, repeat five or six times and the medications themselves start becoming a significant issue (e.g. if you are taking three or four medications, all with a possible side effect of dizziness, you can put your money on falls happening often).

I also understand that you are not retired, as I was when I had to deal with all this, and that the time commitment is significant. Your best defense is being very organized.

Do note that you want your mom to make the medical decisions .. just be sure she actually completely understands the treatment options and needs for them. I had an "Ah ... " moment when I went to a doctor visit with one relative and they chatted with the doctor, was alert, aware of context etc. But when talking with the person after the visit, it became dismally apparent to me that the doctor's information basically went in one ear and out the other. The ability to understand and manage their care was very marginal. Your mom might or might not be in this situation. But look for it.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by InMyDreams »

ralphboy wrote: Thu May 25, 2023 10:32 pm She was seeing a retinologist. She had laser done once and many shots in each eye. She changed her primary care physician and she was against my mom getting the shots in her eyes. She asked my mom if they helped her and she said no and that her vision was getting worse; so we cancelled one of the shot appointments (She wouldn't have been able to go anyways). They take images of the back of my mom's eyes each time she goes for the shots, so I would assume they could tell if they are working or not. I don't understand why the primary care was against the injections.
Wow. Again.

In my state there's a no-cost low vision service that evaluates for functional/living needs, and sells assist devices at their cost. They would know about assist-services in the community, too.

If your mother isn't already on the distribution list, there's a free Library Service for the blind. Audio materials, so no requirement to learn Braile.
https://en.wikipedia.org/wiki/National_ ... t_Disabled
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by biscuits »

TN_Boy wrote: Fri May 26, 2023 10:59 am

I can say that you probably want to understand the total list of your mom's prescriptions. You might find, as many of us have, that the list is amazingly long. I spent a lot of time trying to get relatives off medications that were no longer needed, inappropriate for their age (dosage required for a 30 year old versus a 70 year old) actually interacted badly with other medications, etc. The problem is specialist one writing a prescription for condition A, then specialist two writing a prescription for condition B, repeat five or six times and the medications themselves start becoming a significant issue (e.g. if you are taking three or four medications, all with a possible side effect of dizziness, you can put your money on falls happening often).
Lots of good advice from TN_Boy, a real voice of experience (who gave me good advice when I posted a question here about managing my late husband's care a couple years ago).

A couple things:

1) When I was managing my late husband's medications, my son found the Medisafe Medication Management app for me. It was very helpful. You can enter all of the patient's (or your own) medications, dosages, and timing, and you can set reminders for each dose. The app is also helpful every time a new doc or nurse asks you for a list of the patient's medications. And the app tells you if it sees any bad interactions between drugs the patient is taking.

2) Several people have asked if your mom has Power of Attorney and Healthcare Power of Attorney documents. This is very important. And the more detailed the Healthcare Power of Attorney documents are, the better. A lot of people think that these documents just cover "Do Not Resuscitate" decisions or authorise "pulling the plug" in an obviously hopeless situation, such as when a person is on life support. But there are many more nuanced situations to consider. My own advanced directive, for instance, states that "if a return to a meaningful life is not possible" I choose to forgo antibiotics, blood products, life-prolonging surgery, artificial nutrition, and various other measures. I know from experience that it is very painful to enforce a loved one's advanced directive, but that you can do it if you know that you are acting on their specific wishes. If you and your mom have not had these discussions, a hospital social worker can help you.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by CapeLinda »

There are really good points in previous posts. I would add

You should be able to get a good idea of her functional status from the rehab. The SW will coordinate - however the licensed therapists will give you a better idea of her maximum safe abilities. There are services for low vision available where I lived - unfortunately, people are not always referred to the correct services, coordination of services is also a major issue. Agree with comments re home care including licensed therapists, nurses on her discharge home to ensure carry over of safe plan. Elder services are also very helpful in knowing local services available/eligibility criteria.

Medication interaction is a major issue as indicated. There are specialists in this area.

Advocacy - its becoming more important for families to advocate for services, coordination of services and quality of services especially with the elderly,

Best of luck - going forward with your mom.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by ralphboy »

Several people have asked if your mom has Power of Attorney and Healthcare Power of Attorney documents.
No she does not. How does she go about doing this?

I spoke to the case manager at the hospital today and she gave me a phone number to get help about assisted living from a place called Care Patrol. I'll call Tuesday morning.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by InMyDreams »

ralphboy, I don't think anyone has mentioned: FMLA would likely protect your employment if you took time off to assist your mother in her current medical problems.

"The FMLA allows eligible employees to take up to 12 work weeks of unpaid leave during any 12-month period to care for a new child, care for a seriously ill family member, or recover from a serious illness"
https://en.wikipedia.org/wiki/Family_an ... ct_of_1993

You would need to make sure that all the rules apply in your situation. And if you do use it, it may be best to take portions at a time, and save some just in case there's another emergency (whether your mother's, another family member's, or yourself) within the 12 month period. I believe your employer may require you to use any PTO until it runs out.

Also, some employers offer an employee benefit of assistance locating services for family members.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by biscuits »

ralphboy wrote: Sat May 27, 2023 10:39 pm
Several people have asked if your mom has Power of Attorney and Healthcare Power of Attorney documents.
No she does not. How does she go about doing this?

I spoke to the case manager at the hospital today and she gave me a phone number to get help about assisted living from a place called Care Patrol. I'll call Tuesday morning.
Your conversation with the case manager sounds promising. I believe that with the right discharge orders, Medicare will cover these services for several months, so do ask about that.

Regarding the Power of Attorney documents for financial and healthcare decisions: I'm not a lawyer--all is can tell you is how my late husband and I did it: we had our lawyer draw up these documents for us when we were revising our wills. My husband was a doctor who had seen many end-of-life scenarios, and we had a detailed discussion with our lawyer about life-prolonging measures we would and would not want (yes to supplemental oxygen for comfort; no to supplemental hydration and nutrition, etc.). These documents sat in a file for a dozen years, and then we needed them.

If your mother (and you) do not have a lawyer: maybe other posters here can recommend how to get a reliable, low-cost lawyer in Florida.

Maybe others also know about reliable do-it-yourself or downloadable methods. The hospital might have a boiler plate Advanced Directive for healthcare. I don't know if that would enable your mother to designate you (and your brother?) as the person to make decisions on her behalf is she is unable--that is an important piece of this.

You have a LOT on your plate right now, but you can make headway on this while she is in the hospital or in rehab. The sooner the better on basic versions of these documents, and if you want fancier, lawyer-crafted ones later, you can upgrade. Hoping for a full recovery for your mom, and forgive me if I am being too dark, but I know from painful experience that for a fragile elderly person, the recovery period after broken bones can be precarious, with risks such as stroke and pulmonary emboli, particularly if they are in a lot of pain and resist getting up and moving as directed by hospital and rehab staff.

Good luck to you and best to your mom.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by nonnie »

I am surprised that the hospital/her doctor has not suggested or even required the DPOA and also a POLST -Physician orders for life sustaining treatment (this document has different names in different states). These documents are essential to ensure treating physicians follow your Mom's wishes or yours as her surrogate/agent should you be making the decisions for her.
Please do not delay on getting these documents in place ASAP while your mom is still able to sign them!!!


Below is more information and links for each of the two documents. I know you have gotten a lot of recommendations for agencies to contact and I'm sure this is very overwhelming to you. Please consider finding an agency that will consult with you on your various options including available facilities starting with rehab. This can be a for-profit agency at no cost to you as they will be paid by the facility.(I don't know where you are in the process of consulting an attorney for help, they should also be able to refer you to a reputable agency) Obviously you need to be careful and make sure they are experienced and reputable and not just sales people. A good agency of this type can help with all of the services you may need going forward.
https://www.careforflorida.org/a2r_flor ... lities.htm
You mentioned Care patrol and this is a similar type of service
https://www.carepatrol.com/

Sooner rather than later would be the best time for an attorney, but until you get that all in place here are some suggestions.


https://polst.org/
https://polstfl.org/contact-florida-polst/

Hospital social worker should be able to assist with both documents and notary if required.
https://www.nerdwallet.com/article/inve ... ey-florida

How to create a power of attorney in Florida
1. Create your official document. You can work with an attorney, use estate planning software or download forms from the state of Florida. Select your agent and indicate when they can act on your behalf. Include this information in your document.

2. Sign your POA with the required notary and witnesses present. Have two disinterested witnesses for a designation of health care surrogate, or two witnesses plus a notary public present for any other POA. You, your witnesses and (if required) your notary all need to sign this document.

3. Store your document in a safe place with your other estate planning documents. Tell your agent where the original is and give your agent a copy.

The very best to you. I know from experiences can be very difficult and the more paperwork you get in place now, the easier it will be going forward. As many others offering advice have said, this comes from personal experience. Hang in there.

4. Provide a copy of your POA to other relevant parties. You may want to give a copy to your medical caregivers and financial institutions, for example. If your POA involves real estate transactions, file a copy with your land records office, which in Florida is known as the Clerk of the Circuit Court & Comptroller's office.
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by hvaclorax »

Synthesis of the above excellent advice will help. Surely a professional can be found. You shouldn’t have to go through this process alone.
Sorry. It’s deplorable that this situation exists in the first place.
Your mother deserves better. Don’t give up. I feel for you.
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ResearchMed
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Re: Doctor says my mom should be in an assisted living facility but we can't afford it

Post by ResearchMed »

If your mother is still competent, then yes, *do* try to get a POA so you can make decisions on her behalf.

Try to make sure it's a *Durable* POA (DPOA); that will continue in force if/when she becomes incapacitated, which is when it's most likely to be needed. (If it's not "durable", it is likely *not* to be of any use if she becomes incapacitated.)

RM
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