Home Health Aid(1)

RIggsRaven

Hi,

New to the forums.  My mom has alzheimers and she lives in her condo.  She cannot live here alone, and needs care 24 hours a day.   Us, the children, take shifts. 

She needs help with everything, including how to go to the bathroom.  She is homebound as she cannot leave the house.  I was looking at her insurance, she has BCBS and Medicare Part A and B.

I was looking to see if we can get a health aide in the home to help with some basic living tasks, like bringing her to the bathroom and tell her what she needs to do.  We have to even remind her to urinate when she is on the toilet. 

She does get a monthly income and also owns her condo, which she doesnt want to leave and go into any assisted living facility.  Not even sure if thats an option.

I guess the reason for writing this, how does one get the insurance to pay for a home health aide/nurse  without giving up all her assests?   From what I read, the only way she can get a home health care from Medicaid, which she doesnt have, but in order to get that insurance, she has to give up all assests.   

I just dont understand the lack of support from her insurance companies that she has paid into for years and now when she really needs the help, they offer very limited services.  Its very frustrating.  

I figure people who have been through this and was able to get their insurance to pay for some services, you all would be the ones to know.  

Sorry for venting, Its getting worse and worse and we are all exhausted.

Rick4407

Hello Riggs, sorry you have to be here.  I am sad to advise that the consumption of her assets is what is USUALLY required.   Some states have more liberal Medicaid coverage, most do not.  It is a program administered by each state.  You can list your state of residence and someone here may be able to offer more specific information.  You really need to see a CELA, (Certified Elder Law Attorney) in your state.  They will explain how to qualify for Medicaid and assist in the process.   

The other thing you need to do is take her to a neurologist or geriatric psychiatrist to get her drugs to help control her behaviors.  There is no cure for the disease, only meds to help control behaviors.  

This is a long and very difficult road, good luck.  Rick 

harshedbuzz

RIggsRaven wrote:
New to the forums.  My mom has alzheimers and she lives in her condo.  She cannot live here alone, and needs care 24 hours a day.   Us, the children, take shifts. 

Hello and welcome. I am sorry for your need to be here but happy you found us. 

It's great that you are able to work as a sibling group to cover her care-- that's an unusual situation. 

I guess the reason for writing this, how does one get the insurance to pay for a home health aide/nurse  without giving up all her assests?   From what I read, the only way she can get a home health care from Medicaid, which she doesnt have, but in order to get that insurance, she has to give up all assests.   

The short answer is that you and your sibs need to sit down with a CELA --yesterday-- to ask about Medicaid planning in your state. Programs for assistance and care vary a great deal. Medicaid is a very different animal in some states compared to others. Even local programs like senior day programs seem to come and go based on the whims of local agencies and funding. You can find a CELA here:

National Elder Law Foundation (nelf.org)

Regarding the bolded, it will be helpful for you to adopt the attitude that she isn't "giving away" assets, she is using them to provide for her care in old age. A CELA can help you figure out if there's a way to preserve some of what she has at this point or not. Some states allow trusts to be created fairly late in the game.

I just dont understand the lack of support from her insurance companies that she has paid into for years and now when she really needs the help, they offer very limited services.  Its very frustrating.  

Medicare is medical coverage. This is not considered a medical need. It provides assistance in the home or SNF/rehab under very limited circumstances and for a relatively short time-- after an accident, surgery or qualifying hospitalization for instance. It does not provide custodial care (i.e. a "babysitter" for an adult who can not be left at home or who needs prompting for ADLs).

Medicaid does have programs to cover more custodial help. In some states they even provide aides for a few hours of in-home assistance in an attempt to avoid placement but the goal here is to save money (8hrs in home 5x week being more cost effective than 24/7 placement). That said, I understand that sometimes it is difficult in some communities to find workers even when the funding is there for them. Sometimes there are subsidized low cost day programs which can be a great stop gap to provide breaks for caregivers during the day.

I figure people who have been through this and was able to get their insurance to pay for some services, you all would be the ones to know.  

My mom paid out-of-pocket for dad's care. Had he lived long enough, he would have gone on Medicaid and she would have been a "community spouse" which would have allowed her home, some savings, and money to live on. After she passed, Medicaid would have sought reimbursement for the cost of his care from her estate. But this is a different situation assuming she has no spouse. There is a loophole that allows a family caregiver to keep the house if they lived with a PWD providing a level of care that kept the person out of a facility's Medicaid bed-- you might want to ask the lawyer about that.

I'm sure none of this is welcome news for you. Sorry. 

M1

Welcome Riggs.  Everything HB said is correct, it's a shock to a lot of people when they realize that Medicare does not cover in-home care except for short periods after an acute hospitalization.  Agree with her suggestion that you consult a knowledgeable CELA.  They are versed in financial planning.  Your options are likely going to be spending down her assets to qualify for Medicaid or paying out of pocket.   From the sound of it, unless you siblings can afford to chip in and pay for private care in her condominium, the options are likely to involve selling her condominium and using the proceeds to fund her care in assisted living or memory care (or, I suppose, at one of your siblings' homes if that's at all an option).  If the funds run out before she dies, she can then qualify for continued coverage under Medicaid--so when you look at facilities you may want to consider which accept Medicaid funding (not all do).  

It does vary by state, and that's why an attorney familiar with your state's programs can be helpful.  There are also rules about how and when the assets are spent in order to qualify (can't be gifted away for example).  Some CELA's offer a one-time free consultation and fees can vary, but given the cost of private care ($8-10K per month is not uncommon) it may well be worth the expense.

RIggsRaven

Thank you all for responding.  This was really helpful. Ill be trying to locate a lawyer near her.

Since I posted my OG post, the doctor feels at this point she needs to be in AL/ MC.  TBH, we are all tired, we have our own families, jobs, etc. and this has taken on a full time job.  Im not heartless, just tired.

None of us thought we would be dealing with this or even discussing putting our mom in any facility.  But now we understand why people do it. 

Dad past about 8 yrs ago, so she has been living alone in the condo in Naples FL.  She loves it there and really doesn't want to move.  

We discussed me moving in with her, since I rent and Im practically living there as it is, but then I worry that once its time we decide she needs more help then we can give, what happens to me?  Not sure I  can even afford the rent in FL these days.  

She has amazing ins.  bCBS, Medicare, and vets insurance.  But it all comes down to that medicaid.  

So frustrating.  You're damned if you do and damned if you dont. 

Not to sound political, but it does make you wonder what the heck you work so hard for, for trying to save money, putting money in your retirement and when in the end you have to give it all up to get health care.

Maybe Ill just retire earlier then I plan and when my money runs out, Ill go on medicaid.

I know I sound horrible but just disappointed in the 'system', plus im tired and frustrated.  sorry for my vent

dayn2nite2

You don’t “give it up.”  You SPEND your own money and when you run out, THEN the government helps.  

Don’t move in with her, place her and sell the condo, use the money from the sale to pay for placement.  She needs memory care, not assisted living.

Phoenix1966

dayn2nite2 is correct in pointing you to Memory Care and not Assisted Living. Most AL facilities work with residents who are still somewhat active and do not need much ADL assistance. Your mother sounds like she needs much more “hands on” help, like with her toileting, than any AL facility would take on. Save yourself some time by focusing on MC only. 

Hopefully, someone in the family has a DPOA for her legal and medical concerns. Please don’t put off visiting a CELA. Most offer an initial consult for free. 

ZackFootInMouth

Phoenix1966 wrote:

 in the family has a DPOA for her legal and medical concerns. Please don’t put off visiting a CELA. Most offer an initial consult for free. 

Really?     

 

Also I was made aware that Medicaid isn't free either; after being used, they will collect on the insurer's assets; not sure if the next of kin would be responsible for reimbursement.

Phoenix1966

Yes. My first consult last year lasted 1.5 hours and was free. Call around until you find one that offers an initial consultation for free. Be aware that most don’t have immediate openings, free or paid. You could be waiting for weeks. That’s why members here always urge people to reach out to one immediately.

As for Medicaid Estate Recovery, this article should help explain the process:

https://www.ncoa.org/article/what-is-medicaid-estate-recovery-and-how-does-it-work

Joydean

You mentioned vets insurance. Have you checked with the VA to see what benefits she can get? I ask because my husband is a veteran and we get a caregiver for 11 hours a week. That’s not much but it gives me some time to get out of the house and take care of myself. It’s worth checking into.