My grandfather is in a rehab facility following a hospital stay but is going to be released in a few weeks. He had a caretaker coming in three times a week and when she walked in, she found him on the ground and no one knows how long he was lying there following a stroke. He lives in WA and I am on the other side of the country. He needs at least daily visits but we think for his own safety that he should be in an assisted living facility. The problem is that he has already drained his assets but he makes too much from his social security income to qualify for Medicaid. Even the increase in caretaking costs to have someone come in daily would be more than we can afford as a family. None of us have much disposable income and we can't put a dent in the cost of daily caretaking, let alone the cost of the assisted living facility or a nursing home. We are concerned about his safety but also, no one is in a position where we can take him in. I'm out of my element and really need help navigating these waters. What happens if he needs care but can't afford it? Is there a way to forfeit his income so he can qualify for Medicaid? What options does he have?
They have a finder tool that will help you access resources and find out what's available in Grandpa's area in Washington for either in-home care or long term care. It includes a link to Area Agencies on Aging in various counties.
dshs.wa.gov/altsa/resources
The key person here to be in touch with is the social worker at his current facility. THEY need to assess what the proper level of care is upon discharge and can probably hook you up with good local resources.
Talk to the SW and find out if they see him staying with them as a Long Term Care patient and if they will accept him "medicaid pending".
I did this for my Mom. When she receives her monthly SSA deposit, I transfer over to her QIT the exact amount of funds needed to pay all possible medical bills for her for that month. In her case, the Patient (financial) Responsibility to the the nursing care facility she is in, and her dental insurance. The balance due to care facility is paid via Medicaid.
Elder lawyer will resolve this for you.
There's a great website called Washington Law Help (.org), with a lot of great info that might be good to read before contacting an attorney. I'd recommend reading a document called "Questions and Answers on the COPES Program." On the homepage go to the section on Seniors, then click on In-Home Care/COPES.
In Washington State, COPES stands for Community Options Program Entry System. It covers in-home care, as well as care in an assisted living facility or adult family home (a privately owned home licensed w/ the state that provides care for up to 6 residents). (Note these are different than skilled nursing facilities/aka nursing homes, which have different rules and are under a different Medicaid program in WA.)
The Q&A on COPES will explain how someone can qualify, how much income the individual keeps as a "Personal Needs Allowance," and how much they pay toward the cost of their care. Unfortunately, yes, if living in a residential community the facility will take the majority of the person's income and they get to keep a small amount for personal expenses. The state will pay a certain "daily rate" to the facility based on an assessment done by a DSHS social worker. So people with higher care needs get a higher daily rate than people with lower needs- the facility must then balance how much $ they'll get with how much work/staff time the person will take. When someone lives in a facility with the help of Medicaid the majority of expenses are covered--room & board, meals, utilities, most medical expenses (the state subsidizes Medicare), incontinence supplies, as well as Durable Medical Equipment. Their personal needs allowance can be used for things like clothing, personal items, fun outings, etc.
The big issue you will find, however, is finding a facility that will take him on Medicaid right away. Please note, I do not say any of this to discourage you, but to just let you know what you may come up against. Many assisted living facilities and adult family homes in Washington do not accept Medicaid at all, because the reimbursement is so low. The assisted living facilities that do, at least in Western Washington, usually require at least a 2-3 year private pay period before allowing a Medicaid "conversion" after the person has "spent down" their financial resources. They also have only so many Medicaid "beds," so if one becomes available, it is usually filled by someone who's already been living there & paying privately. Sometimes if they don't have anybody ready to convert and one of their spots is available, they may take a new move-in on Medicaid, especially if the person has a high participation/income (because they'll be getting a large amount from the individual on top of what the state's daily rate is for that person). So the best thing to do is ask, because you never know and you might have good luck!
Do you think he could return home with in-home care? He'd be able to keep more of his income, but he would likely pay a high participation if he has a high income (see the Q&A on COPES). Because he'd still be in his own home, he'd still have to cover all his own living expenses and utilities, bills, etc. The COPES program does not provide 24-hour care in the home. So if he is truly needing 24-hour care, he might be better off in a facility.
I hope this information helps! You can also call the Area Agency on Aging that is local to where he lives, as they might be able to offer advice and provide referrals for local facilities, in-home care options, elder law attorneys in the area, etc.
If your parent qualifies, by a doctors assessment, for the home health benefit, Medicare covers the following types of care: Skilled nursing services and home health services provided up to seven days a week for no more than eight hours per day and 28 hours per week (Medicare can cover up to 35 hours in unusual cases).
Types of home health care that Medicare will pay for - Medicare ...
www.medicareinteractive.org/.../types-of-home-health-care-that-medicare-will-pa...
Maybe you can balance it out with private care for the other days and nights. You can use his SS and perhaps all the siblings can chip in a little.
If your dad was a good dad, getting the siblings to chip in should be easy. If not, if he was abusive or self-absorbed, they may not want to help you.
Lastly, Medicaid has a five year look back for any gifts given in order to qualify for medicaid.