Finding someplace that accepts Medical

LizQui

Hello,

I am trying to help my step-father, who was diagnosed in December with Dementia of potential 3 different / co-morbid varieties (VD, FTD, or LewyBody).  He was never one to plan for the future in any capacity.  As such he doesn't have private insurance, or long term care insurance.  The doctor has diagnosed his stage as being to the point where he needs 24 hour care.  I am the only person available to help, and I have to work. I can't afford to leave work and care for him.  Even if I do, I have a home and a family.  For various complications, I can't move him in with us.  He has lived alone for a reason.

 He has some capacity to be independent. He can do his own laundry, shower, and prepare sandwiches (his preferred meal).  He can't navigate technology at all anymore and can't drive. 

What kind of facility would best serve his needs?  I'm not sure how assisted living or nursing facilities differ.  Does anyone know of any in CA that accept Medical?

loveskitties

If his doctor says he needs 24 hour care, then he probably needs memory care or a skilled nursing facility.  The doctor should be able to tell you which best fit his needs, be able to confirm with any facility the diagnosis and might also know which facilities in his area take Medical.

Be aware that just because they may take it, they may not have beds available.  Very few places devote all their beds to Medicaid type patients.

LicketyGlitz

Liz, when you say Medical do you mean Medicaid? If so, I think I got some suggestions for you. If not, disregard everything below!

When you start researching ALs or MCs make that your first criteria, that they accept Medicaid when/if your step-dad's funds get low enough to transition on to it. These communities will help you with the process of applying which ain't the easiest thing in the world to do, and it allows him to stay in a place he's already familiar with instead of having to move due to insufficient funds.

It sounds like assisted living would be a good fit for him now, but it won't remain that way for too long, so another question is asking if they have memory care at the same community. When he's ready for MC the transition again won't be so traumatizing for him and all of you who are caring for him if he's just changing buildings in the same complex.

Good luck to you and your step-dad!

[Deleted User]

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Jo C.

Hello Liz and a very warm welcome to you.  In California, the insurance that pays for Long Term Care is, Medi-Cal.  NOTE:  Long Term Medi-Cal is different than regular Medi-Cal.

Did the doctor make any suggestions regarding the level of care he feels your step-father needs?

What city or what area of California do you wish to find a placement?

For most of us, we simply use Google and the telephone to make calls to find out which facilities accept Medi-Cal for long term care; then we make a personal visit to find the best fit.

There are businesses that advertise they can find placement for families, BUT they only provide names of those facilities that are on their contract list - they do not charge the patient or family; instead they get paid a considerable sum by a nursing home when they place a patient there.  In this model, one misses many really good facilities because they are not on the list because many do not contract with such a business.  In the past, before I knew better, I once used a larger one of those businesses and it was really a very negative experience.  Miss too many fine facilities that way and got a list of more undesireable ones.

Medicare does not pay for Long Term Custodial Care.  They cover acute hospitalization and outpatient care as well as short times in rehab after a qualifying inpatient hospitalization of three or more days, but nothing for long term nursing homes, memory care, assisted living, etc.; so you are looking only for Medi-Cal.

There are also residential care homes where six or so individuals are cared for in a home setting and some take Medi-Cal.  Not as much activity or staffing as in the other models of care.

NOTE:  It may be more difficult to find a Memory Care setting that accepts Medi-Cal; many of them prefer private pay only; but there are some that do.

It is difficult to tell specifically what level of care would best suit your step-father from the information provided.   Many of us have found that when we spend a week or so in our Loved One's (LOs) home, we find that they are far more compromised than we had been able to realize.

I would like to suggest that you call the Alzheimer's Assn. 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 welcoming, very supportive, have much information and can often assist us with our planning and problem solving. 

When discussing criteria for obtaining Long Term Medi-Cal, the state is making it easier to qualify.  The following two links share much information.  The one from CANHR discusses the positive change in Medi-Cal financial criteria which will take place in July.  Both are informative links.

If there are assets to do so, it would be a good idea to consult an Elder Law Attorney to ensure that all paperwork is in order.  That particular specialty is necessary as there are so many bits and pieces that go into planning for care.   First question would be, do you or anyone else  have a Durable Power Of Attorney for your step-dad?  A DPOA for Healthcare and another DPOA for Finance would be best in order to assist your step-dad now and in the future.

http://www.canhr.org/factsheets/medi-cal_fs/html/fs_medcal_overview.htm

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

It is important to note that canhr's input regarding asset limits will go way up in July 2022:

"It is expected that around July 1, 2022, the state will raise the Medi-Cal asset limit for an individual to $130,000, $195,000 for a couple, and $65,000 for each additional family member. "

Any income your step-father has would go to his "share of costs" for Medi-Cal.  If he has too much income to qualify there are ways to assist with that; an attorney can help you with that if it is a problem.

It is important to place in a facility that can care for him on his worst days and as his disease progresses.   Some families will place  their LO in Assisted Living only to find out that their LO cannot manage there and has to be moved.  Assisted means just that; assisted with not much personal oversight and management for someone who is highly compromised.

Memory Care can be helpful, and there are many of them; each one can be a bit different in how they are set up.  This means we have to look up the facilities online and then we have to visit the possible facility we may want by making a personal visit.

One thing:  If one can pay up front for a month or two of a facility that accepts Medi-Cal, it will be easier to place.  Reason being, your step-dad would apply for Long Term Medi-Cal after his admission to care.  If he qualifies for Medi-Cal, the family is reimbursed for up to three months of payments.  If he does not qualify for Medi-Cal then the facility is not out any money.

One does not have to have an attorney to apply for Medi-Cal; one can do it oneself being careful to fill out the application in its entirety; AND there will be a lot of documentation to provide such as state ID, social security card if one has one; discharge papers from the military if the person was in the military; divorce certificates; marriage certificates. death certificates if a spouse has died, etc.  That was the most difficult part for me, but it does get done.  Medi-Cal has a listing of what documents they will wish to have a copy of.

Even if you have an attorney make an application to Medi-Cal for you; you will still have to provide the documents.

We were fortunate in that it took only a bit over a month for my LO to be approved for Medi-Cal and we got back our initial payment from the care facility as Medi-Cal will pay for up to three months of care retrospectively.

 This is a lot of information, but I do not know how much information you have already received.  It would probably benefit you to contact the Care Consultants at the Helpline, it will give you some personal input and discuss your step-father's needs.

You are a very kind and caring step-daughter; your step-father is blessed to have you looking out for his care.  Let us know how you are and how things are going. 

We are all here in support of one another and that now includes you too. 

J.

F

This is a very difficult position to be in. If staying in his home is still an option but with more help, the Agency on Aging might be able to assist you if he is receiving Medicaid. Also there are Hospice programs that also provide in home care beyond the typical 6 month end of life expectation. That referral has to come from a Dr. and be an end of life type of diagnosis, but the Hospice program could assess further and is more comfort care, managed by in home nurse visits and less medical interventions. 

I am in a similar position with my Mom, who at 91 was dx recently with dementia/Alzheimers and she lives alone in an apartment but with help. She has Medicare and Medicaid which covers her personal care aids, a medical alert, meals on wheels etc.  But I am her power of attorney now and do all of her other tasks including managing her medications, paying bills and cooking additional meals for her. 

When the time comes that safety is too compromised for her to live alone, even with help, I will be looking for Skilled Care facilities that accept Medicaid and have memory care within. 

Best of luck to you.