Where will she go? Where CAN she go?

Ginsamae

Well it appears that MIL's extended stay at Sib #1's house will be short lived. Sib #1 and spouse are saying that it's too draining on them and that they can't handle MIL's revisions of family history and constant messiness.  DH and I have already boxed her stuff up and DH has let it be known that MIL cannot and will not come back here to live as we are closing in on the birth of our grandchild (and are busy making all the preparations and living space for daughter & child) in our home. 

My question to you all - does MIL need to be a resident of the state she's in in order to go in to a care facility? MIL will not be able to self-pay for any care and will have to get on Medicaid. MIL is still, technically, a resident of VA because when she first moved in with us DH took her to get a state-issued ID and she registered to vote (and did vote in the 2020 election - what an adventure that was!). I know that Sib #1 will NOT do those things so I doubt MIL could be considered a resident of their state (she's only been there for about 5 weeks). MIL still does not have a formal diagnosis of anything other than diabetes - but it is painfully obvious to everyone that she has dementia of some sort. I'm just not sure of what to do next and I know that she cannot come back here to live. 

Any helpful advice is gratefully accepted!! Thanks in advance.

Jo C.

This is indeed a challenge and one that is probably not going to be solved easily due to multiple different issues of which cooperation and work by the adult children will be the driving factors.
 

The Alzheimer's Assn. has a 24 Hour Helpline that can be reached at (800) 272-3900.  If you call, ask to be transferred to a Care Consultant.  There are no fees for this service. Consultants are highly educated Social Workers who specialize in dementia and family dynamics. They are very supportive, often have much information and can often assist us with our problem solving.

That being said; your mother had been considered a "resident" of Virginia; however, she has "moved," and is now a resident of a different state.  It appears she has not got any new ID for the state she is presently in.  It would be helpful for that to be done, but it will take cooperation of your sister and her husband, but I do not think that affects her residency status.  Often, Medicaid requires a photo ID for the Long Term Care applicant; sometimes a driver's license, other times a state photo ID.  For my LO, she had no photo ID nor did her husband. They were unable to go to the DMV, so the DMV sent out two people who took photos in the home and filled out the applications.  We got the photo IDs within a couple of weeks.  Not all DMVs do this, but it can be worth looking into.

  
A second issue is that there is no diagnosis for dementia despite the symptoms she is presenting. She needs to be seen by a doctor for a current exam and assessment of her conditions.  The physician should be made aware of all of her health history as well as the problem issues with changes in cognition, function and behavior.  An exam will be done, meds screened and labs ordered.  With this, the physician can make a diagnosis for what he/she feels is present.  This will be helpful as she will need a current exam for placement anyway as well as current diagnoses for her health conditions.

 Medicaid for Long Term Care is different and separate from regular Medicaid and must be applied for separately; it is my understanding that if a person had Medicaid LTC in one state, it cannot be transferred to another;  one would have to reapply all over again.   SO . . . . if your sister and husband refuse to move forward and find a facility in their state and make preparations, it may end up being up to you to take care of that; so in that case, your mother would have to qualify for Long Term Medicaid in Virginia and not your sister's state.  Also, since it can take from one to three months for qualification to be made once the application is received, sometimes a NH will require a deposit up front for a couple months coverage just in case the application is denied. In most states, once a person qualifies for Long Term Care, the state will reimburse for up to three months retrospectively, so the family would get their money back in such a case. It would be worth checking this out.  It may be that if a deposit is required, both adult children may have to pony up part of that money so it does not all come out of one pocket just in case an application would be denied.
 

 It is important to remember that not all NHs accept Medicaid, so one would be best served at looking at only those faciliities that have a Medicaid contract. It is also important to know that while there are more NHs that accept Medicaid for Long Term Care, less Memory Care facilities do.  A lot of homework and a bit of planning to get things going should ensue asap.

  If your sister and bil are not going to cooperate with getting your MIL to the doctor and looking into Medicaid for LTC and then finding an accepting facility and making application to Mediciad, this may end up falling back onto you once again should you suddenly find your MIL on your doorstep.   AND . . . . remember that there may well need to be a deposit made to the NH until such time that the Medicaid application is approved IF it will be approved. 

 An Elder Law Attorney is always best for good information and positioning oneself; but that attorney must be in the state the Loved One is going to be placed and living in as laws differ from state to state.

 I think this is something that needs to be worked out with sister and bil and you and your husband, between the two couples.  It is going to take some work to get it all done, but there seems to be no other alternative.  It seems to be a matter of just who is going to be willing to do what needs to be done.

 Let us know how it goes, we will be thinking of you,

 J.

Quilting brings calm

I don’t know about  residency rules for Medicaid. But I would think her actual presence in a  residence in those relatives home would qualify for residency,  along with a written statement from you saying she moved there and no longer lives at your home.  No one questioned my parents having Alabama licenses when we moved them up to Illinois. My mom didn’t get an Illinois ID for over a year.  You could always ask her doctor to send her a bill to your relatives home.  Give your relatives address  to her bank  and have them send her a new statement, Illinois DMV accepts a medical bill and or a bank statement ( can be printed on your home computer from banks’  website ) as  proof of residency. 

Hold firm.  Even if she has to establish residency it won’t take long.  Let your sister in law figure out what to do with her now. They promised a year and they’ve only lasted 6 weeks.  They can do what needs to be done to establish residency. Do  not agree to take her back and do it in your home state. 

Cynbar

I can only speak about my own state of Massachusetts, so I'll keep my comments brief. Here, proof of residency is usually satisfied by a copy of a bill sent to the person at an in-state address. This is usually a medical bill, medical insurance bill or utility bill. So, whatever address she gets her bills at currently would be the easiest one to establish residency.But I want to add a couple other quick points. I know you have posted before that she gives away too much money as gifts ---- depending on the amount over the past few years, it is possible she could be denied Medicaid. And --- again, at least in my state --- patients have to be screened to determine their need for a nursing home level of care if Medicaid will be paying. I have definitely known patients who didn't pass that screening. A diagnosis would be very helpful for you in that regard. Good luck, I know how trying this whole journey has been for you. And congratulations on the new grandchild!!

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harshedbuzz

Ginsamae-

You've already gotten some good advice. Especially from Victoria.

Who holds the POA? That's the person who should be making these decisions. 

Since you didn't specify the state(s) in your post or in your profile, I can't speak to whether Medicaid will pay for MC where you live or where your MIL is living now. It will not in my state, but will a mere 8 miles away on the other side of the river. If you have a choice between states, I'd go with the one where there are beds available.

That said, when we were planning for dad's care, we were told that Medicaid would pay for custodial care in a SNF if that level of care was required. Since MIL doesn't even have a diagnosis and seems to be in a moderate stage, it is unlikely she would be deemed appropriate for that level of care at this time. 

HB

abc123

I agree with everyone else, especially Victoria. 

I wish you the best! Enjoy your own family and the wonderful baby that’s coming!

aod326

A gentle reminder that if you start solving these issues, you're going to be right back to where you were before. Your MIL is no more or less DH's responsibility than his siblings. Having leapt the huge hurdle and moved her out of your house to another family member, don't let that have been for nought.

I think DH's siblings have spouses too? They are all people able to Google and/or come onto these boards to get the info themselves. To give some tough love to you: don't enable them!

dayn2nite2

My God, I’d be outside digging a moat around my house, filling it with alligators and then installing a 20-foot fence with razor wire at the top about now.  You KNOW they’ll tell you you just have to take her back.

Ginsamae

Dayn2nite2 - LOL!  I just told my daughter that I'm going to barricade the door and put man-eating critters all around the house to keep her from coming back!

Fortunately, DH is on my side and is sticking to his guns about her not coming back here.

The whole situation is a big, fat mess - no one in the family has DPOA (or any other paperwork) and MIL doesn't have a will - she says she won't sign anything but checks because we only want her to sign legal documents so we can put her in a 'home.' That, coupled with no diagnosis, and no money, makes this one big mess. Sib #1 doesn't appear to be in any rush to get her to a doctor in their state, but her Metformin and Xanax Rx's have no more refills so they will have to do something soon - her doctor here has said that since she moved out of state then he can't really continue to prescribe medications for her.

I sincerely appreciate all of the advice I have read. I had already decided that I am completely DONE being the only person doing any research, especially since I share what I've learned and what I feel should be done next and am completely ignored by those who have the responsibility to care for their mother (and yes, I'm including DH in this). I've decided to let THEM figure out what to do. I've also let DH know that if his mother steps one foot in our house I will pack a bag and move out until she leaves. Stick a fork in me, I'm done.

abc123

Day2night, you had me rolling on the floor!!!!!

dayn2nite2

The great thing is the baby is coming and soon you’ll be helping your daughter take care of the baby and being a NORMAL GRANDMA.  It’s so sad that the overly responsible people worry so much about situations like this.  This is a time to enjoy your life and your daughter and sorry, no room at the inn for MIL.

abc123

Gin, if you dig the mote, I'll send you some piranha's to go with the gators! 

When my daughter was born, it was such a special time for my momma and me. She gave my daughter her first bath when we brought her home from the hospital. I cherish that time in my life. This time spent with your daughter will always be remembered and valued. I'm very happy for you all.