Nursing Home Admittance Challenges - any ideas?

Jo8

Hello, I am hoping someone can give me advice or tips regarding nursing home admittance

My brother was diagnosed 4 years ago in his late 50s, and the doctor said he could not live alone any more.  He never married, and has no kids, so overseeing his care falls on me.  He started to develop incontinence after the 1st year of diagnosis, which seemed quick, but I’m told it varies with each individual.   Over the past year and a half, his condition has deteriorated. He no longer senses his bladder or bowels, which has resulted in total incontinence.  Afterwards, he seems to be oblivious that he has soiled himself.  If asked, he denies he has wet or soiled himself, although it is clearly obvious to anyone in his presence. My husband and I are older and cannot continue this path.  Due to the level of care he requires, his income even with state assistance, is insufficient to cover cost of Assisted Living or MC.

 I have consulted a CELA regarding Medicaid LTC qualifications for placement in a nursing home.  I was told he appears to be eligible medically and financially, but I need to get him placed in nursing home (NH) knowing that we will be applying for Medicaid LTC (Medicaid pending).   Apparently, in FL you need to be inpatient in nursing home in order to apply for Institutional Medicaid. I do not know if this is the case in other states.  Unfortunately, I have not been able to find a NH that will admit him as Medicaid pending.  I am told either that there are no Medicaid beds open, they will not accept any more Medicaid pending because they have an excess of patients pending Medicaid, no open beds at all, or the NH does not return my calls. No one seem able or willing to admit him when he does not currently have approved medicaid.  Has anyone encountered difficulty getting PWD admitted in NH and have ideas on how to address?  I appreciate any suggestions.

loveskitties

If a skilled nursing home is not available, have you asked for a Hospice evaluation to see if you can get skilled care in your home?  Not ideal but would give you some help until a better solution is found.

Have you spoken to anyone at your local Counsel on Aging (social services)?  They may be able to assist in some way.

The only other thing I can think of is if he were admitted to a hospital for any reason, you can tell them you can no longer care for him in your home and let their staff try to locate a place for him to be released to.

I wish you and your dear brother the best possible outcome.

King Boo

Most people end up in Medicaid LTC via a rehab stay in a snf after a 3 day qualifying staying in the hospital.  Even here, there is a strategy to having your first, second and third choice of a nursing home lined up via research and visiting - in this case, you are looking for not only a rehab stay but a facility that will convert the patient to LTC.  Being able to provide this to the hospital social worker increases your chances of success - but honestly, I did all the phone calls, legwork etc to get in for a rehab stay myself, including showing up as requested at 7am to complete admission paperwork for rehab.  Squeaky wheel, sort of thing.

Coming from the outside in, there are usually very long waitlists and a limited number of Medicaid beds.

Our exception was our excellent county nursing home - did not really matter to them.

Some nursing homes may view you more favorably if you have a limited amount of private pay set aside, but that takes planning in advance of need.  If the CELA didn't mention it, I suspect this is the case. 

Jo8

Thank you, loveskitties and King Boo! I really appreciate your responses.  I am aware of the hospital route, but he has never required hospitalization. Getting into SNF from the outside seems virtually impossible, but I will call facilities again to inquire about waitlists.  I've spoken to my Area Agency for Aging, but was not aware of hospice evaluation or the Council for Aging.  Thank you again for the information you provided, your experience, and well wishes. It is helpful!

Sjodry

I was going to suggest the same thing loveskitties said. If your brother has any hospital in-patient stay (don’t know if this would apply to an ER visit with an acute condition like a fall)..and you were adamant that you could no longer care for him, that requires the social work department to find a placement for him. They are not allowed to release him if he is not safe.

Good luck.

Sandy

Jo C.

What a stressful time; I am so very sorry.  In most states, a person must be in a NH before they can apply for long term Medicaid for custodial care.   It is beyond sad that most Memory Care settings do not accept Medicaid patients.

One way that some manage to get their Loved One (LO) into a NH as a Medicaid Pending, is to make a good deposit up front.  Some facilities will want to see a month's fee in advance, others would want to see up to two or three months deposit.

The reason for this is, that if the person does not qualify for Medicaid and is denied, then the facility does not lose money.

In most states, when a person does qualify for Medicaid, the state will reimburse up to three months of fees that the family has paid for.  You would need to check this out with your attorney.

We did this with my mother.  We paid two months up front and we did get it back when her application was approved.

If you are able to do this, you may want to ask about this when screening facilities.  That "pending" makes NHs a bit concerned because they have been "burned" multiple times in the past.

Florida is one of the most difficult states when it comes to accessing a bed in a NH. Perhaps your attorney will have suggestions for where placement might work, or he/she may even have a contact that could be helpful.  The Ombudsman's Office for your area may also have knowledge about what facilities may be most likely to work with you.  You can find the Nursing Home Ombudsman Office in your area online; they are the folks that handle NH complaints, they will know all the facilities in your area.

The sad thing may be, that you will not be able to get him into the NH of your choice and may even have to accept a lesser one; however, if that happens, once he has Medicaid, it will then be easier to find a place you are more comfortable with as he will already have that Long Term Medicaid.

The Alzheimer's Assn. has a 24 Hour Helpline 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, have much information and can often help us with our problem solving. 

I so hope there will be a way to find a spot very soon, please do let us know how you are and how things are going. We will be thinking of you and we truly do care.

J.