Paying for Custodial Care

LadyTexan

When I spoke to the treatment team at the Psych Hospital, they indicated that DH needs "custodial care". My understanding is this is not skilled nursing care.

Are any of you aware of assistance programs that can help me pay for "custodial care" in a facility?

Texas has a Star Plus+ Waiver program that assists for paying for care at home. As you all have suggested, DH and I will not be safe if DH comes home. What are my options? Should the psych hospital discharge team be talking to me about the options?

I am feeling really LOST and especially stupid.

ladyzetta

Dear Lady,

You are NOT stupid and please don 't think that. But as far as lost I totally would feel the same way. Remember you have a lot of friends and supporters here who don't want you to feel that way. 

Bringing your DH home as you know is not a safe thing to do and he needs more care then you can give him. 

When it came time to place my DH I talked to the Senior Support Services in our state. In our case we qualified for Medicaid and placement was done. You can do it!!  Be strong and talk to any agency regarding senior care.  There is help out there, but please don't bring your DH home while searching. 

You count and you need to take care of yourself right now.

Hugs Zetta 

Ed1937

Hi Lady. I read the posts from your other threads, but there were so many posts, I didn't think I could add anything of value. I'm sorry you are at that very hard time in your life, but rest assured you are doing what needs to be done. No looking back.

I was able to find a resource finder, but haven't used it. It might be of some help for you when you answer a few questions. Also, don't forget to read the ads on the left side of the page for other possible options. I hope this can help at least a little. Don't pass something up because you think the age disqualifies DH. https://www.payingforseniorcare.com/resources/locator_tool  

Quilting brings calm

I think I saw something that said Medicaid might pay for custodial care if it was provided in a nursing home  setting.  Maybe ask about that?  Unfortunately that would not be memory care,  which I know is your preference.

Cynbar

The psych hospital has a responsibility to make a discharge plan. They will talk to you about your financial situation and Medicaid eligibility. If you have spoken with a CELA, contact him/her first thing tomorrow . The goal is to start the Medicaid process ASAP unless you have a good amount of private funds to pay for a few months of care. The social worker/discharge planner at the psych hospital will (or should) tell you which facilities your DH qualifies for, based on his care needs, that also accept Medicaid. In Massachusetts, Medicaid doesn't cover memory care, but I have no idea about Texas. You don't have to navigate this yourself. Just make clear to the discharge team that you need to give approval to the facility they arrange. The choices may be somewhat limited because of your DH's history, but hold firm -- they have to make a safe plan for him, and going home with you is not a safe plan.

dayn2nite2

They’re using that terminology to imply that you may end up on the hook financially if you don’t take him home.  Refuse to have him discharged into your care and tell the discharge team he cannot come home and they need to get him placed and he’ll need Medicaid.  Medicaid may not pay for “memory care” but it sure will pay for a nursing home so if that’s where they can place him, fine.

Continue telling them you are not bringing him home and they need to figure it out.

Crushed

In plain language

THEY ARE BULLSHITTING YOU

AS SOON AS THEY say CUSTODIAL CARE THAT IS A bullsh-- WORD

This is why I tell people repeatedly never to listen to anyone but your own lawyer   they are rewarded for throwing   bullsh-- at you  

 the key is activity of daily   What can he do for himself by himself?    Programs for Memory Care

STAR+PLUS

The STAR+PLUS Medicaid waiver provides care to seniors aged 65 and older, as well as adults with disabilities. The program provides participants with reimbursements for the cost of residential memory care, as well as services such as physical and occupational therapy and transitional assistance services for seniors who are transitioning from a higher or lower level of care.

• Who is Eligible:Seniors who wish to receive benefits under the STAR+PLUS waiver must be at least 65 years old and financially eligible for Texas Medicaid. As of 2019, the household income limit for an individual was $24,731 per year, while the limit for a couple was $33,482. Additionally, seniors applying for STAR+PLUS must medically require long-term care.

• How to Apply: To apply for STAR+PLUS or to learn more about this waiver program, seniors or their representatives can contact their local Area Agency on Aging or visit Your Texas Benefits online. This is not an entitlement waiver, which means that seniors may have to be placed on a waiting list before they’re eligible to receive benefits.
  
  
  After saying all that My BIL was a lifelong Texan and a Judge He and my sister were both  sick and they left Texas for a state with  more civilized treatment of the sick.   

Stuck in the middle

Lady Texan, they are just saying that your husband doesn't need a "medical level of care."  My mother had labile hypertension and VD.  She went to a SNF (skilled nursing facility) where her blood pressure was checked several times a day and meds adjusted as needed.  The hospital arranged it when she was discharged.

Your husband does not need a medical level of care.  So, he is not going to a place where an RN is on duty 24/7 to adjust meds, provide wound care, etc.  He is going to a place in which he is supervised, provided regular meals and meds, etc.  Most importantly, he is going to a place in which he is not dangerous to himself or to you.  The hospital can arrange this as well.  My son went from hospital to an RCF, and the hospital arranged that as well.

This will be handled, even in Texas.  I live in Missouri, another State that disdains public services, and it was handled here.  

My mother's SNF employed a "social worker" whose main job was to do the paperwork needed to keep the money coming in, and my son's RCF has a similar person.  I imagine that all such institutions have the same.

M1

LT I would insist that they start the Medicaid eligibility process-again, they do this all.the.time.  As already said, they are legally responsible for a safe discharge plan, and home is not an option. So it is up to them to identify where he could potentially be placed and who will accept him.  I would not be surprised if it takes several more weeks for this to be arranged, but so be it. It is theirs to do, in consultation with you, but I would absolutely keep the monkey on their back, not yours. You are more or less an interested bystander at this point.

Part of the issue may be that the discharge planners are not around on weekends. You may get more information tomorrow. Do NOT offer anything, I would keep repeating the mantra that home is not an option, period. 

[Deleted User]

The user and all related content has been deleted.

Crushed

 some resources but you need a disability lawyer

 

https://www.elderoptionsoftexas.com/article-hiring-a-certified-elder-law-attorney.htm

https://www.hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/providers/resources/pasrr/pasrr-item-by-item-guide-pl1-form.pdf

Preadmission Screening and Resident Review

Preadmission Screening and Resident Review (PASRR) is a federally mandated program to ensure that any individual seeking admission into a Medicaid-certified nursing facility or currently residing in such a facility is screened and evaluated for mental illness, intellectual disability, and developmental disabilities, regardless of the payment source.

PASRR Level II evaluation -- A face-to-face evaluation performed by a local authority at the location of the referring entity or nursing facility to assess an individual's need for care in a nursing facility or other setting, such as an intermediate care facility for individuals with an intellectual disability or related conditions.

 

https://www.youtube.com/watch?v=8wv30d9UysE

Donr

Good information Crushed

Mint

(((Lady Texan))) So thankful for people on here who can give you helpful advice.  In fact I’m going to save some of this post in case I need it sometime.  We have so many different resources here from people from all different walks of life.

The only experience I have is from working in medical system.  I’m going to tell you like the others have, don’t go pick him up.  You are not the first one to tell them he cannot come home.  Tell them kindly but very plainly I am not taking him home, the reason I am not taking him home is because I am not safe with him there and he is not safe there.  So a plan must be found to place him somewhere where  he is safe.   Anything they say repeat the same answer.  They will get him placed somewhere else in my experience, though I am in a different state.

Twin Mom

What about the state hospital in San Antonio?  If it is unsafe to bring him home, and you can’t get onto the Waiver program it might be an option or at least you questioning the availability might give them pause for thought rather than having him pushed into your care.

We are using UT Geriatric Psychiatry in San Antonio with bvFTD.  If you would like to connect please do.  I feel uncomfortable stating more on a public forum.

Jo C.

Important Links:

Compassionate Fast Track Disabilitiy Benefits for Young Onset Dementia (under age 65): 

https://www.alz.org/media/documents/alzheimers-dementia-social-security-disability-insurance-ssdi-checklist-ts.pdf

Texas Medicaid Qualification Criteria:

https://www.medicaidplanningassistance.org/medicaid-eligibility-texas/

To clarify for those who are reading and unaware; "Institutional Medicaid," is care within a long term care facility; often termed "custodial care."   The term "Regular Medicaid," refers to non-institutional care Medicaid where Medicaid is for medical care insurance in the open community.  There is a big difference between Long Term Medicaid and Regular Medicaid; so when using Google to search for Long Term Care do use that specific term and always; use the current year so you do not get outdated information.

In Texas qualification criteria, only the applicant spouse's income is counted; therefore, the at-home community spouse's income from work, social security, pension, etc. does not count nor are the financial assets  in the community spouses name only counted such as 401's,  IRAs, etc.  The at-home community spouse must also have a minimum amount of income each month; if the community spouse does not have this minimum amount on her/his own, then the income from the applicant spouse can be transferred over to the community spouse each month to reach the minimum amount.  NOTE:  You can see that $138,380 in savings are kept intact for the at-home community spouse and are not counted for Medicaid purposes.

IF the applicant (your DH) has income over the allowed amount, there is a "Miller Trust" which is a Qualified Income Trust that can be set up in which the applicant's income is placed in a Trust.  Each month when the care facility bill comes due, the Trust pays out the money in it to the facility and Medicaid makes up the shortfall.  (The at-home community spouse's income is not counted in this.)

If your husband has young onset disability from social security there should be no problem obtaining Medicaid.  The need for 24 hour oversight care and behavioral issues with mood and behavioral swings are usually qualifications for necessary institutional care for dementia.

Hang in there and of course do not agree to take your DH home from the psych facility; it is their responsibility to assist in finding a safe placement for him; but you too will need to assist with this.  Keep remebering to say, "I will not take him back home - It is not safe for me and it is not safe for him."   Sometimes the patient is in a holding pattern in a psych unit for some time until placement is found.  It is notable that some potential transfer care facilities, when they find out about the behavioral history, will not accept the patient into their care; but other facilities are more capable of managing such care; it may take a bit of time to find that. In the meantime, the patient will be in care at the psych unit until appropriate placement is found.  It happens all the time; your situation is not unique.

And of course, your elder law attorney can answer any questions with accuracy.

So hoping that all of this unwinds itself and a safe solution is found very soon.  Best of luck and best wishes being sent your way,

J.

abc123

Excellent advice and information here. Lady you are on my mind every day. I hope you are feeling better.

A special Thank You to everyone who has shared a link for information. 

JDancer

Jo C. The information you posted looks helpful, but the font is almost illegible on my computer.

banpaeng

Hello Ms LadyTexan,  You need to call Star Plus and go ahead and get on the list.

I suggest that you call a CELA and find the correct answers.  I understand you are not close to Houston but a Cela in Houston is helping me and all by phone.  Her name is Kelley M. Bentley.  Phone number is 281-946-6004.  First  telephone conference is free.  Got nothing to loose and a possibly make your life easier.

Mint

Thinking of you.  Hope you are doing ok

Crushed

Jo C. wrote:

I

In Texas qualification criteria, only the applicant spouse's income is counted; therefore, the at-home community spouse's income from work, social security, pension, etc. does not count nor are the financial assets  in the community spouses name only counted such as 401's,  IRAs, etc.  

 

I am not a Texas lawyer but I am very concerned about This comment Everything I find says that IRAs  etc are countable and including in the 130 K  limit

 

 

Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and one’s primary home, given the Medicaid applicant lives in the home or has intent to live in it in the future and has a home equity interest no greater than $603,000 (in 2021). If the applicant has a spouse living in the home, it is exempt regardless of where the applicant lives and his / her equity interest in the home.

For married couples, as of 2021, the community spouse (the non-applicant spouse of an institutional Medicaid applicant or HCBS waiver applicant) can retain 50% of the couple’s joint assets, up to a maximum of $130,380, as the chart indicates above. However, if 50% of the couple’s joint assets is less than $26,076, the non-applicant spouse is entitled to 100% of the assets, up to $26,076. This, in Medicaid speak, is referred to as the Community Spouse Resource Allowance (CSRA). In order to avoid confusion, it is important to mention that this resource allowance does not extend to non-applicant spouses of those applying for regular Medicaid.

  

Joint of course has multiple meanings .  in the medicaid world it normally means Combined

 

no Co-owned   Texas is a community property state

 

as I said I am not a texas lawyer but her is a clear statement from one who

 is 

 12. Retirement benefits. Retirement plans, such as 401(k) and 403(b) accounts, IRAs, and other qualified and non-qualified retirement plans, are countable resources. It does not matter whether the plan is in the name of the Medicaid applicant or the spouse. However, if the retirement plan is unavailable for withdrawal, the assets are excluded for Medicaid eligibility purposes. If funds can be made available only through a loan, termination of employment, or a hardship approved by the plan administrator, the funds are not considered available. HHSC does not require the ineligible spouse to terminate his or her employment, apply for a hardship, or take out a loan.
  https://www.thehalelawfirm.com/ourstory/

  

banpaeng

In Texas any community assets are countable except a residence and one car.

You can also have a spend down which does not mean spending money.

AS I am NOT a lawyer, that is as far as I go.