Is in-home care/assistance possible for financially challenged?

Texas16

TX., Hays county

I look after my mother who has been diagnosed with ALZ and dementia.  Trying to keep her at home for as long as possible due to only having enough savings for around 8 months in a memory care facility.  Currently about 30 hours into a bad episode.  Would be nice to have someone to call/assistance during times like these.  Not medicaid eligible and seems all the in-home care options are an out of pocket expense.  Anyone know of options/resources available?  Realize this could be a UTI issue but, other than trip to E.R., have to wait till Monday for primary care physician to assist.

Rescue mom

You can get at-home OTC tests for UTI, but they are not perfect. You absolutely can take her to the ER; they will know elders with a UTI can be a very bad thing, both behavior-wise and becoming worse infections. 

The ER also may be able to give her some calming meds. I’m not clear on her behavior issues, but UTIs can cause serious behavior changes/problems.

Has an attorney told you you’re not eligible for Medicaid? Many, many people are surprised at how Medicaid is more available than they thought or heard.

You can also call the Alzheimer’s Association 1-800 hotline number, on their website (or someone else here might have it at hand) and ask for a “care counselor” who can talk to you about all/other issues. They’re available all week, as I recall.

Your local Alzheimer’s Association (many local offices are not open on weekends) may point you to local sources or groups or attorneys etc. that can help. 

Since she has the Dx, you should already have papers with power of attorney and health care and financial authority (?) If not, you need them ASAP.  The AA can help you figure out the paperwork you need.

From my experience, there’s not much other financial help out there, but some places have more than others.

Texas16

First, thank you for reply.  Didn't know about the OTC UTI tests.  Her primary care physician is a godsend and has no problem with me coming by to pickup a UA container, then bringing it back.  Only problem, closed on Sat and Sun.  If current episode/behavior continues, will definitely take her to the E.R.  Only problem, hospital in this town and neighboring towns treat ALZ patients like the modern day version of lepers.  Haven't spoken with a lawyer yet, but on the to-do list for Monday.  However, all other avenues of medicaid exploration haven't been positive.  Do have the medical and financial POA's taken care of.  Unfortunately, it's just her and myself.  No assistance from other family members.  Would be nice to have someone to call for temp support during these bad episodes that could come by, like an overnight stay, and allow me to sleep.

DawnOfANewDay

My mom has a similar issue (also on a week-end) and we went to a free-standing urgent care center.

Lindsay22

I'm in PA so not sure about TX but there are many "community based" programs here even if you aren't Medicaid eligible that include some in-home caregiving.  My mom is in MC now but before we were cobbling together a variety of services, some out of pocket, some assisted by Medicare.  It was nearly a full-time job organizing it all and getting all the assessments but there are some limited services.  Do call the Alz hotline, they can offer guidance.

mommyandme (m&m)

Not sure how deep into the diagnosis your mom is but if she needs assistance with many ADLs, maybe hospice could be on board. You could get some help there too, if she was admitted into their system.

Jo C.

Hello Texas16 and a very warm welcome to you.  It is now Monday, and I am sure you have contacted your mother's physician by now.    NOTE:  It is not a good idea to use the home test kits to rule a UTI out; they are dreadfully fraught with a very high percentage of false results.  A physcian should always order a culture and sensitivity of the urine sample to ensure reliable results at the lab. 

When turning a sample into the lab, I usually ask for two extra sterile urine containters so I always have them at the house.  One can either turn the sample in to the doctor, or have the MD order the lab online and you can drop it off at the lab if it is near you. 

Medicaid:

You do not mention just why your mother does not qualify for Long Term Care Medicaid in Texas.    Long Term Care Medicaid is not the same as Medicaid for everything; they are different from one another and need to be applied for separately.  I am assuming you are discussing the Long Term Care Medicaid.

If your mother spends down her income sufficiently to reach the amount required in Texas to qualify for facility long term care,2,000 in her savings, that is her share of costs responsibility - once she spends down that eight months worth of her savings, so she has no more than $2,000, it will then put her in the qualification arena

NOTE:  If she spends down her savings, but her income is too high to qualify for Long Term Medicaid there is a way around that.  Texas, like many other states, permits a "Qualified Income Trust," often called a, "Miller Trust," to be done. In this, the income is placed in a special Trust that is set up.  Your mother's income would be placed in that Trust. Each month when the facility bill comes due, the income in the Trust is paid to the facility and Medicaid then pays the rest of the shortfall of the monthly fee.   Many people are unaware of this Trust, but it has helped a lot of people to be able to qualify.

There are "Waivers" in Texas for providing care in the home with Medicaid, but those Waivers are very limited to only so many a year for the entire state, so you would have to work with that to see if it is workable for you if that is the path you wish to take.

Your mother need not sell her house outright to qualify for Long Term Medicaid (if she has a house), but when she passes away, then Medicaid will need to be reimbursed up to the cost of her care . . . . ONLY IF she has the assets to do that.  At that point, her house would be sold UNLESS . . . . in most states, if the adult child has been living in her house and has provided her care for two years prior to care facility admission, the house usually does NOT need to be sold and the adult child can continue living in it as long as they wish.   If your mother does not have assets to reimburse Medicaid, then that is simply usually written off.

Here is a link to 2021 information regrarding Texas Long Term Medicaid qualification criteria:

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

Always a good idea to speak to an Elder Law Attorney when making plans in order to protect oneself as much as posssible. If it is her income that is problematic to qualify, then the attorney can discuss the special, Qualified Income Trust with you.

I send best wishes for this to turn out just right for you and your mother; let us know how it goes and how you are ; we will be thinking of you.

J.