What qualifies for SNF?

AlzWife2023

We can’t afford memory care. We can’t afford FT home care. I’ve been FT cater for two years. The first year I was still very angry and in denial. (I’ve been angry at him for years now not knowing what’s going on, being abandoned, etc). It took about 6 months of working on myself to get to the point now where I think I’m doing a very good job of caregiving, but like many others, I have given up my life and future to do this. I have no retirement etc and I’m completely dependent on Medicaid & SNAP and help from my children. I used to make over 100K. I’m setting myself up to be a burden on them later. I’m only 51, it doesn’t make sense. Add in the emotional toll.

So I’m finally thinking that it’s my decision whether to place him or not and I don’t want to give up the rest of my life out of guilt. None of my children can or should give up their lives to care for him. Full time care at home would cost me my whole paycheck and I’d still be caregiver nights and weekends while working and doing all the household chores! No thank you! It feels like it’s him or me now.

So I’m wondering what would qualify him for covered placement. He has Medicaid & Medicare, no assets, small SS check. I guess he’s moderate stage. He can’t do any IADLs. He has been evaluated for adult foster/family care as needing prompting for one ADL and assistance with two others plus resistance to care. (Bathing, changing clothes, etc). I’m good at getting around him and using all the techniques and tricks to avoid confrontation but I just really don’t want to do this anymore. He’s losing his teeth; he’s not brushing them. That’s become a big fight abd I don’t have endless energy to coerce him at night when he’s most combative. It’s impossible.

I know there is one SNF near us that has a memory care unit. (They have a separate memory care building that does not take insurance & costs 11K I think.) I’m thinking this one is good.

How do I get him in there?

Jeanne C.

I don't know where your located, but in some states Medicaid will pay for in home care (we're in Delaware and my husband qualified for 40 hours/week based on inability to do many ADLS).

I haven't attempted to place my husband but others, I'm sure, will have advice. My best guess is that you could start with your local council on aging to get some advice. Or your husband's case manager for his Medicaid insurance (though I'd try to get an idea of what should happen before I talk to the case worker as they work for the insurance company and may not volunteer all options to you).

harshedbuzz

@AlzWife2023

He'll need to qualify for long term care Medicaid which may impact you if you own a home or have other assets and are a legal spouse. A CELA can advise you on qualifying in your state and doing the least damage to your financial future. He will need to qualify for this level of care although generally, that's not difficult at a point where a PWD can't be left alone. You could be offered some in-home care if he doesn't qualify.

Additionally, you'll need a facility that accepts Medicaid and has a bed available. These are typically very limited and urrent residents who have been self-pay during a spend-down period are prioritized.

https://www.medicaid.gov/medicaid/long-term-services-supports/institutional-long-term-care/nursing-facilities/index.html#:~:text=Nursing%20Facility%20Services%20are%20provided%20by,primarily%20provide%20three%20types%20of%20services%3A&text=Nursing%20Facility%20Services%20are,three%20types%20of%20services%3A&text=Services%20are%20provided%20by,primarily%20provide%20three%20types

H1235

In my state we have a Medicaid waiver. The waiver will cover the cost of AL assuming you meet the requirements and are selected. It is all very complicated. I would definitely call your local commission on aging. They can at least put you in touch with the correct people. When I first started asking questions for my mom I made many call’s before I got my questions answered. And that was just to learn some basics, we haven’t even started the application process yet. There is a lot to it. Before you get too set on a place you may need to learn a bit more about what is covered. Good luck.

AlzWife2023

https://alzconnected.org/discussion/comment/211406#Comment_211406

thanks. I know finding a bed can be difficult. We’re not legally married & he lives in my home so that part is not a problem.

AlzWife2023

thanks for the good advice. I was wondering if he’d qualify based on the Alzheimer’s (not able to be left alone, wandering).

AlzWife2023

thanks

Hope5757

Hello @AlzWife2023 -

I’m glad you posted as I’d wondered how you were.

There are a number of SNF vs MCF on the site as I was curious also. The consensus of the experts was that there had to be a specific underlying condition that called for medical intervention - wound changes, IVs, etc.

From what I read, dementia alone rarely qualifies.

I can’t recall- what was the reason your DH wouldn’t qualify for a MC placement paid for by Medicaid?

AlzWife2023

I really don’t know anything about placement. Yet. The one MC place I spoke with said they don’t accept Medicaid and I guess I’m working from that.

I guess I’ll have to explore more places.

Thank you.

M1

in some states (including mine) Medicaid only covers nursing homes and not memory care or assisted living at all. It varies from state to state, that’s why it’s wise to consult an elder law attorney in your state. Unfortunately the coverage is pretty limited.

jfkoc

Here is a resource to look at'

https://www.ncoa.org/article/does-medicaid-cover-memory-care

MC facilities are not the same as SNF. They do not offer the same care.

Jeanne C.

This might give you some idea about the rules in your state. But, as M1 suggests, an elder law attorney would have the best information for you.

https://www.medicaidplanningassistance.org/state-specific-medicaid-eligibility/

AlzWife2023

thanks to all who responded. I don’t think we’ll ever place him. I was just feeling so burnt out & I guess that anger never disappears. I am working on ways to have a life and be a caregiver.

AlzWife2023

Thanks @Victoriaredux for all the good suggestions. I’m sure I won’t place him, but getting back to work is a must. Luckily, during my last monthly fit I applied to a few jobs and one has hired me in the last week. It’s part time, which is ideal for now, and I’m so ready to get my head back in the game and to make new contacts etc. I realized how crucial it is to do this and it’s my priority to make it happen.

Iris L.

Hello AlzWife. PWDs need care 24/7. How can you do that and work part time? Do you still have the dog? If I recall, you live on a farm or in the country. Caution: if you overburden yourself, you won't be able to work or to give care. Take care of yourself! Best wishes.

Iris

AlzWife2023

Hi @Iris L.
Thank you for your concern. I am just seeing this now. You are 100% right. I think I’ve finally come to the full realization that I am a full time caregiver and that’s not gonna change. I’m accepting help from my children and no longer considering working outside the house. I still have my dog who is no longer a puppy and consequently much better behaved. I took my trip to Ireland a few weeks ago (the one I postponed last year) and it was fabulous. My son built a fenced in play yard for the dog this summer. Things are progressing nicely. I have a lot of support and it’s a work in progress. I will have days where I’ll wish things were different but I’m working on making this reality the best it can be.