I posted a few days ago about the challenges with my mom. We filed an appeal with Humana who had denied her going to rehab for the 3rd time, after 3 long hospital admissions. They approved the appeal, so now a bandaid is in place to get her to a rehab. But, she needs long-term care! I think I have all the documents I need now for the Medicaid application and countless people have told me the social workers in the facility will be able to help me with it. My mom had been "temporarily" staying with my grandma and aunt for 2 years after my dad passed, but then she had a heart attack and a stroke and "temporarily" came with me for a year. I regret taking her in honestly. The plan was for her to recover with us, which she did and because my grandma has dementia and is difficult, and then find senior housing. She was lazy and it took many months of hounding her to put in apartment applications. She made her room a pigsty and had so many bathroom messes. I would literally cry to her about destroying my home and it didn't phase her. There is definitely something mentally wrong with her but she never wanted to seek help.
Anyway, back in April she was having some alarming symptoms and got admitted into the hospital and terminal stage 3 liver cancer was found. Immunotherapy is the only treatment option, to possibly help extend her life. She was in the hospital for 3 weeks, home for 2 days, back in for a week and a half, home for a week and half, and now back in the hospital for 2 weeks. The times she was home were a disaster. Horrendous bathroom messes, not taking her meds and insulin, letting her catheter bag with the fluid from her stomach leak all over, etc. She cannot come back to my home. I cannot deal with her level of care needs so she needs to be in a SNF. But, my sister who is against this (but has no means or real intentions to care for my mom herself, just to guilt me into it)/ She used to be a social worker and keeps saying that after we go through the Medicaid app process, Medicaid can still deny a nursing home for her. But can they really? A terminal cancer patient who cannot care for themselves and has no home of their own? Then who is a nursing home for?
You make this your mantra and do NOT waiver or let the DP, or the Social Worker or others goad or guilt you into doing this. Be firm and clear. If your not good at going all bad witch mode, role play this so that you can do it and stay firm.
Sam, so mom is right now at home but abt to go to NH for rehab, is this it? If so, her rehab time will have a time clock attached to it. Maybe couple of weeks. It’s real interdependent on what diagnostic codes (ICD -10 codes) she is discharge to rehab for. Let’s say it’s 15 days. So in theory she has rehab Humana insurance coverage for 15 days BUT she has to, HAS TO, be participating in her rehab and making progress. If mom is all maybe manana on doing rehab, the PT, ST, etc are not going to force her. What will happen is that after 2-3 sequential days of being maybe manana, she will be written up as nonparticipatory for care and goes off rehab. This is kinda done in real time. & the insurance will shut off rehab benefit right then. Quick & abrupt. Your mom has lots of other health issues, and is used to being self determining…. I’ll bet she will be nonparticipating for care and rehab will be over b4 it starts. So that being said, I’d be letting the rehab / NH place know from day 1 of her entering that you are concerned about the level of care she seems to need as you know you can never ever provide care for her in your home. EVER. Make yourself notes as to when you said this w date & time. This way when you get that phone call or get stopped in the hallway while visiting her, you are ready with your mantra and can detail that you have made this clear since xyz and to abc.
oh and never ever sign off anything with just your signature. If you are the POA then on every line you do it as “Jane Smith Jones as POA for Mary Smith” and get a copy of all. If they balk or seem too busy…. Do a screenshot of every page with your phone and print it out once you get home. If Sissy is the POA, then deflect and say Sissy needs to sign.
Barb is right that as she has a fat medical file, she will be ok for being “at need” medically for LTC Medicaid.
I’d be more concerned to if, IF, in the past 5 years that she has given $ to Sissy or has paid for debts of Sissys. Financial look back for “at need” can require up to 5 years. What seems to be done now is rather than 5 years of back statements, it’s past 6 mos - 1 year and then the bank statements for every year for 5 years from the date of the Medicaid application. If she files Aug 1, 2022, then all financials from July 2022 - July 2021 and August 2020,’19, ‘18, ‘17. Medicaid requires their “awards letters” which are those income to be paid statements that SSA and retirements send out Nov/Dec for incoming year. So Medicaid knows what mo income is and what bank balance was in 2017. They x reference property sales so know if mom sold her home for 100k in 2018. Info goes into an algorithm caseworker uses. If mom gets 1800 a mo income, had a balance of 85K in 2017, sold home for 100k in 2018 and since lives rent free with family and is now impoverished, it’s gonna be red flagged as she should still have 6 figures to $ to spend down to private pay for care. Medicaid can ask for details on checks written for larger amounts. If you know that Sissy got serious $ from mom, or has mom pay Sissys car note, etc., I’d try to get Sis to deal with the LTC Medicaid application. Hopefully this is not at all the situation.
Good luck with all this and do let us know what happens!
I presume she now has a fat medical file, enumerating her need for skilled nursing.
What about her financial need? Have you worked with a Medicaid planner or eldercare attorney? Has mom been doing any gifting to relatives?
Why would you listen to your sister?
My dad passed 3 years ago so she's had all this time to find a place since she always claims she really wants to live with my mom but it was easier for her to not spend a dime and just live off others. Heck, my mom even offered to pay rent and just asked my sister to pay like 2 utility bills so they could get a place together but she "couldn't afford it". She's in her mid 30s and works a professional FT job and a PT night job 🙄. But now that it's "crunch" time she's all concerned, but I'm the horrible one.
Your sister is a louse. Unless SHE wants to take care of your mother herself, she gets NO say and has NO right to try to guilt you into anything. If she and your mother insist on immunotherapy, S gets to take care of mother. You've done YOUR turn -- tell her that. If she doesn't want to take HER turn, then it's SNF for your mother. Please remember that whether or not your mother gets immunotherapy is NOT up to you. It's actually up to your S.
Be aware that she might lie to you that if you take your mother back in "temporarily," that help will be forthcoming. It's not going to happen. Same lies that Discharge Planners use to get the family member to take the elder, because then the DP can cross that patient off their list.
Just keep reiterating to the Discharge Planner that you cannot take care of your mother and that they have find placement for her after her time at rehab is up.
That's really vague. "Soon" might not mean the same to you as to the oncologist.
Is there any way you can reach out and ask what, exactly, is the time frame that encompasses his terminology of "soon"? And why, after that time frame is reached. wouldn't she be able to do it at all? Is it because she's too far gone into the cancer?
"Immunotherapy is the only treatment option, to possibly help extend her life."
Again, very vague. Has the oncologist given you any sort of idea of the odds that this therapy will indeed extend her life? And what sort of quality of life can she expect while she is doing the therapy? Is there an end date to it, or is it something she's going to have to do for the remainder of her life? Sometimes oncologists will push for treatment that has awful side effects for a really minimal amount of "extra" time. That's what happened to my MIL with her lung cancer treatment.