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Insanity
What happens to people who need memory care, cannot afford it, but are not eligible for Medicaid funding for supportive living?

I was astounded to find out that in most, if not all states, Medicaid funding for supportive living/memory care facilities is not a available for those with incomes over $1400/month or so.

So what happens to those people who have cobbled together a retirement income of say  $1800/month and have used up all their assets to pay for memory care but have years left to live? Surely, not all of them are being cared for by long suffering daughters and daughters-in-laws. 

Currently, memory care facilities charge $5,000+/month. I have yet to find one that charges $1800 month. So what happens to those folks who do not have relatives willing to take them in?

Some are eligible for the VA A&A benefit. But that is only $1000/month, still several thousand dollars shy of the required five grand.

What happens to these people? 




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ESQ
Unfortunately they lose their life savings and they often take their children down with them either through becoming an involuntary servant or by a child paying the bill to avoid becoming an involuntary servant.
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Middlegirl
This is truly frightening. I guess I need to read up on "spending down". Could it possibly as simple as going to the Gambling establishment or racetrack, and putting all the money on a horse or the turn of a card? Or does it have to be a long drawn out tedious affair?
MG

BTW- it would not let me post this message with the "word for gambling establishment that begins with a C and ends with an O, like the places is Las Vegas.... Hmmm...funny!
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Insanity
"
Unfortunately they lose their life savings and they often take their children down with them either through becoming an involuntary servant or by a child paying the bill to avoid becoming an involuntary servant."

But what about those who do not have children or the children they do have are not willing or able to be involuntary servants or do not have the means or the inclination to pay the bills?

Surely, there are people like this. What happens to them? I have talked to numerous assisted living/memory care facilities who state that they are self pay only. When the money's gone, the resident is discharged.

Where do they go? 

Homeless shelters? Snuck into a SNF under an iffy diagnosis so they qualify for Medicaid? Are there charitable organizations that are caring for them?




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mike

I'm not sure I know what "memory care" is.  In my experience, there is only Assisted Living, and Nursing Home, aka, skilled nursing facility.  As far as I know, Medicare does not pay for assisted living (aka "custodial care"). 

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'daughter'(beth)
I understand what you are asking, Insanity.

My mom had enough savings (thank god) that she could pay for a couple of years of Assisted Living (Memory Care Unit), before all her funds would have run out. By that time, she probably would have been a candidate for full-blown Nursing Home care (medicaid).

However, what if after those 2 years, my mother was not at nursing home care level? You have to be in pretty bad shape to get transferred from assisted living to nursing home. I think a lot of these elderlies do get transferred to nursing home (and hence, Medicaid) when they are not necessarily at that level yet. All it takes is a Doctor's approval (I think). Maybe it depends on which State one lives in.

However -- what if Doctor says "Nope, she is not nursing home level yet" then what happens?? She has no funds left to do self-pay at assisted living, and no funds to pay for nursing home care (which is definitely VERY expensive).

if there is no (insane lol) relative to take in this elderly parent or grandparent who is not at "nursing home care" level yet, what happens ?? The funds have run out. But she cannot go on Medicaid.

I would bet that a lot of these people end up getting transferred to nursing home, on Medicaid, because of this exact scenario. And there is no one to take them into their home. Because remember, as of today, adult children or grandchildren, or any relative, are not by law required to take this elderly person into their home. Not to mention, if the adult children work, the elderly parent no longer has any money that would cover the cost for in-home care while the adult children are at work. In-home care is even more expensive than nursing home care depending on the level needed.

I have written about these "gray areas" a lot, it is disturbing. There are some States that are starting to allow Assisted Livings to use Medicaid. But since Medicare and Medicare are tanking, that will become less common, instead of more common.
Many State governments are starting to push the in-home care scenario to avoid (medicaid) nursing home costs. That means, you the adult child are being forced (??) to quit your job and take care of your parent in your own home, or pay for in-home care with a tiny bit of assistance from the government.

Easy for the government to say "let the elderly parent live at home or with an adult child" but .... the devil is in the details.  Which they have no clue about.
end of my rant
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gigi

mike, memory care is high level (expensive) assisted living for people with dementia.  It's the in-between place. 

 

I would hope a compassionate doctor would release a broke assisted living resident to a nursing home rather than send them to a homeless shelter.  However, government audits for medicare/medicaid are increasing and a doctors who doesn't follow strict guidelines can be fined or actually prosecuted for fraud.

 

 

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Insanity
"Daughter" Beth, that is exactly what I was talking about. As I understand it, Memory Care is supported living that is a step beyond Assisted Living.

Assisted Living works for those who need help with preparing meals, keeping medications straight, housekeeping, maybe help with dressing and bathing (though often this level of care involves an additional charge).

Memory Care is for those who need more supervision than this due to declining cognitive status. Often these units are secure (i.e. locked) as some of the residents will wander off. 

Due to their level of dementia, those in Memory Care may not be able to find their way to the dining room or back to their room. They are often incontinent and need to have briefs changed regularly. As their dementia progresses, they may have trouble swallowing and may need to have thickener in their liquids and their food cut into small pieces or even put through a blender.

A nurse manager with thirty years experience in this area told me, in the past, these people would have been placed in a nursing home. However, that is no longer the case. Residents have to have a documented need for nursing care to be admitted these days. Being elderly and continually confused does not meet the requirements. I.V.s, IM injections, wound care... procedures that have to be supervised by an RN are required. She said that many who have had strokes don't even qualify. As long as only custodial care is required and medications, such as pills and insulin injections, can be administered by a med tech, then nursing home placement would not be an option.

As I understand it, county nursing homes have closed down all over the country and the competition for the remaining coveted spots is fierce. 

My Mom lived in a retirement community that provided living quarters, meals, housekeeping, and socialization at a reasonable price. When she needed medication management and help with dressing etc., we looked into what was available and realized that she would run out of money within a few years, so she moved in with my sister and now with me. Had we not done this, she would be out of money now and out of luck as she does not require Skilled Nursing (i.e. nursing home placement) and aside from not knowing which end is up, is healthy enough to live for many years.

We have been able to preserve her savings for when she needs more care than we are able or willing to provide, but I can't help but wonder what happens to those who don't have relatives who will do this? Where do they go?

Is there something I'm missing?

 
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Insanity
As people are living longer and dementia is becoming more of an end of life issue, I suspect we will be seeing an increasing need for memory care custodial care and I don't sense a groundswell of support across the nation to increase funding for programs for the elderly. 

I have talked with a geriatric case manager about this and according to her, the only option in the state we live in is a Memory Care assisted living program that will pick up the unpaid portion of a person's monthly expenses as part of their charitable program.

She said that this is a tough sell to the for-profit continuing care communities but those run by religious organizations will sometimes do this, especially for a resident who as been there for years.


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Insanity
So I found out what happens. I called the Alzheimer's Association hot line who, oddly enough, referred me to an insurance company for long-term care insurance. I questioned this as I hardly think any company is going to offer long term care insurance to an elderly person who is already in long-term care and has run out of money. 

I was right. Where do they get the folks for these hot lines anyway?

So I called county social services and after getting transferred all over the place, finally spoke with a dear soul who told me like it is. According to her, what happens is that the family, or the social worker if there is no family involved, goes to one of the less affluent surrounding counties and finds a place that charges $1800 - $2000/month. I told her I'd toured one of these facilities. It was a dreary place with residents shuffling around in their pajamas at two in the afternoon and no staff in sight. 

She said it was a sad situation, but that's what happens to people who run out of assets. She also said, that Medicaid assistance is only $2000/month in this state, so many people start out at such facilities instead of merely ending up at them.  




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Daddy's Little Girl
I have posted about my experience before, but have been swamped at work and just now have time to re-post some info which pertains to this topic:
   
My Dad was in a locked Memory Care unit IN a nursing home.  He had no medical needs, but a diagnosis of Dementia and possibly Alzheimer's.  Once in the Memory unit, he made the transition to the nursing unit in the same building when he was no longer ambulatory and there was no issue.  It was also a facility that qualified for 100% medicaid beds when your financial status was depleted to the point you could no longer be private pay.  

If you live in the US, and there are 2 people involved (the one needing care and a spouse)you can apply for Medicaid for the one and there is something called Spousal Impoverishment in which the other spouse gets to keep the house, a car and a specific amount of money in order to not bankrupt them.  We used an Elder Care attorney who wove us through the process because we also set up a Pooled Payback Trust fund for Dad with additional $ that would be awarded to the State when Dad passed to help pay for some of his care.  That was because they had money they needed to spend down before qualifying for Medicaid.  Before his passing, we were also allowed to spend money from that fund in order to get anything for Dad that improved his quality of life (this is a broad range - special beds, wheelchairs, aids to read to him, taxi rides for Mom's daily visits, etc.).  Once Dad passed, any money for his care spent by the State over and above what the trust fund held was forgiven and Mom was not responsible.  If any money was left in the fund after paying for his care, it would go to Mom or his estate.  In order to use the spousal impoverishment, Mom still needed to be living independently at the point of Medicaid application and acceptance for Dad - and she was.
 
We also used a Geriatric Care Manager which cost us $125 who met with us once, she also gave us phone support when we had questions afterward.  She helped us determine which level of care Dad and Mom both needed, set up interviews at care facilities which met the criteria WE as a family determined which was:
  • Must have a special Dementia ward
  • Must have both Nursing care & AL for Mom
  • Must eventually take Medicaid
Our experience was that there ARE places out there that will take Medicaid for Memory and that will also transition Memory to Nursing with just the diagnosis of Dementia.  Not that it was easy to find when I was trying to do it myself - like it is a well guarded secret or something!  Using the Geriatric Care Manager really helped us to weave through all the available options in our area.  Because believe me - I remember sitting and crying on the computer trying to find resources and figure it all out myself asking the same questions over and over that you bring up Insanity - I felt helpless and hopeless in the situation and could not believe there was not an option for us. But it turned out there was and the Geriatric Case Manager helped us find it.

Again, this is just my personal experience here with the people and facilities we worked with in Illinois, but I wanted to share again in case any of it helps anyone else.
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Sean
Middlegirl, there is what as known as a 5yr look back on finances. So you can't just say "oh I went to the racetrack and blew all my money".

You have to show where the money went in detail over the last 5 yrs.

In America, they allow the spouse to keep I believe around 106K to live off, might sound like a lot but what if the spouse lives another 10 yrs?

I got a nasty email from someone on this board that I was "unpatriotic" when I said this before, too damn bad, because it's the truth.

I find it DISGUSTING that people work hard all their lives and then get raped by nursing homes and assisted living places.

You're almost better off in this country blowing all your money, not saving, and not working hard and just be eligible for Medicaid.

My mother was in an SNF after surgery for 3 months. She was private pay after 21 days(Medicare gives you 21 days).

It was $140 a day. Most of the people in there were Medicaid. So you get the same treatment whether you're private pay or Medicaid.

Something is out of whack when you have two people in the same room and one is paying $5,000 a month and someone else is paying zero.

As others have said you either have the elderly person live with you, pay out of pocket until all the money is gone, and then hope you can get a doctor to say they can go to the nursing home and qualify for Medicaid.

A very sad state of affairs.

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Midwest

You make some valid points, Sean.

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Middlegirl-Sean
Thanks, Sean, I forgot about the 5 year look back. OMG, my Ndad's finances are like a bowl of spaghetti!
I am sorry you got a "nasty-gram". Can you block the person for the future?
Happy Sunday to all!
MG
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I have just found this website and it has been so helpful.  I'm in NC and my husband has just been kicked out of a 2nd assisted living memory care unit because of violence.  He is 58 and was diagnosed with Alzheimer's and Psychosis at age 53.  Two years ago, my neighbors reported me to Adult Protective Services because he kept getting out of the house (he is stronger than me) and they were afraid of him.  I had to go to court and I have a court order that I can't bring him back home.  His Dr. said he can now qualify for skilled nursing but I can't find one that will take him because of his violent record.  Black Mountain Neuro Treatment Center may take him but it is a 2-hr drive for me.  Does anyone here know about this place?  He will never qualify for Medicaid in assisted living because his SS check is too high.  If I can find another place in assisted living, what happens when I run out of money, which will be soon, at $4000/mo.  His 401K and IRA are gone and mine almost gone ... so much for retirement.

thanks,
elaine
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