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We have been given misinformation from our local Healthcare provider . We were told that she needed a skilled diagnosis to get my mother admitted so on her back xray she had a fragment in her back so the er dr wrote for this and she was to be admitted mon. However the er Dr we had seen before stopped the order by stating that it was healing and her uti was being treated by antibiotics. Meanwhile my mother is another day without the care she needs. I have asked for her to be in skilled nursing because she will not volunteer for physical therapy . What am I doing wrong? Do I need to say longterm? Are the Dr's not getting enough kickback to send her into nursing home? The Dr's said she needed 24/7 care and were told that Noone would be at home to care for her, yet in Henderson county tn they sent her home and stopped her home health . This whole experience has made me very disappointed in the Dr's as people and the health care system. Thank you to everyone who has responded and responds giveing me some direction on where to go now. She has medicare part a n b and a Pekin supplement ins. Apps these are not good enough or I'm not using right words to get her in.

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The answer is yes

This is how my mom ended up in a permanent rest home!

She had another stroke and the neighbor called 911 then she went to the hospital and finally a rest home
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Sthbell1: One suffering from dementia requires 24/7 care.
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1. Have her PCP assign you to a " Case Manager" who is usually a Licensed Social Worker who is usually the interdisciplinary professional to help family navigate care options and facility placement for family members. Do this ASAP .

2. You may also benefit greatly from conferring with an
" elder law attorney" who should provide you with at least a one hour " gratis" consult to present your situation and, then go from there with their on going services as you and they deem appropriate.

3. the PCP or Case manager / Social Worker should / will be sure that your I'll loved one receives a current " level of care needs assessment". This will be a part of the decision process for facility placement.

4. Depending on where/ what stage the dementia has progressed to , the loved one may need/ qualify for placement in a " Memory Care" unit/ facility which can be different than other " skilled care facilities".

Save your sanity and overall health by getting help; one or more of above will be a good start.

Get emotional, spiritual support for yourself regularly from a faith leader or community chaplain of your choice. Practice other good self care/ exercise, hydration,proper nutrition etc., See your own physician as needed.
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Contact the Department of Aging for your county. They might be able to provide some resources.

My dad lived in Assisted Living. He had dementia, CHF, Diabetes and colon cancer. I had in-home hospice set up for him which required 24 hour care. He had to pay out of pocket. Rent was $5,000 and caregivers were $20,000 a month. They wouldn't move him to memory care because he was too "active". A nursing home didn't work either for the same reason.

Also, I believe Medicare only covers so many days in a skilled nursing facility.
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JoAnn29

Traditional Medicare only pays for Parts A and B which means they pay only for your doctors’ visits and hospital stay. Traditional Medicare WILL NOT pay for in-home care or SNF. Medicare Advantage WILL pay for in-home care services for your LO like helping to prepare meals, taking your LO to doctors’ appointments, laundry, shopping, etc., but it’s a limited amount of hours per week that they allow for in-home care. I have Medicare Advantage where I have zero copay and zero premium, plus I get supplies of OTC products of $70 every quarter and fruits and vegetables of $75 delivered every quarter. My Medicare Advantage pays for someone to come in and sit with a LO as companion. These are just a few of the many perks that I get from my Medicare Advantage which I love.
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If your mom does not have a physical illness and is primarily dealing with dementia and maybe something like incontinence, she could easily go to a memory care unit. A doctor can make visits to the memory care unit to see your mom. They can order tests, they can order physical therapy to come in, a podiatrist, etc.

My mom doesn't have any additional illnesses either...no diabetes or anything like that. That is the main reason a long term care facility was not on the table. My mom is still mobile and can eat on her own for the most part. In memory care, they give her meds, help her dress, bathe, serve her meals. It is locked down. We were able to bring in moms own bed, dresser and TV.

Why are you wanting your mom to go to long term care instead of memory care? If the reason is finances, she could apply for Medicaid or a Medicaid Waiver and then you would need to find a memory care facility that accepts Medicaid.

Im not trying to minimize the problem. It takes a lot of work to apply for Medicaid and find a facility that has an open room. From what you have said, I think you're looking at the wrong level of care for her. Memory care seems like a good match.
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Getting a permanent placement in a nursing home where long term care is provided is complex; and the orders of an ER physician are not what is needed.

If there are resources to pay privately, then one likely has a better pick of facilities and most will want to take. Where we leave near an urban area in the east coast area of the US, high quality nursing home facilities (such as they one my mom is in) cost about $15K a month ($180K) a year. Again, if you have those type of resources; there are lots of options.

If there are not those types of resources; then Medicaid (NOT Medicare) is a possibility. To qualify for Medicaid long term care coverage; your LO must meet two tests: 1) be below the asset threshold in your state (this mean all assets!) and 2) meet your state's "level of care" requirement. For the "level of care" the nursing home facility physicians and/or other have to submit "medical reports" showing she needs 24/7 care based on medical conditions AS WELL AS her inability to handle "safely and independently" a myriad of activities of daily living and instrumental activities of daily living. Then YOUR STATE, reviews and make a determination if she qualifies OR not.....In other words, just because any physician says she needs 24/7 long term nursing home care; it is YOUR STATE regulators that make the final go or no go decision.

Many Medicaid and Medicare qualified nursing home (you want both qualifications) like it if a person enters as private pay for a while, while your LO spends down. This option can be easier they just randomly calling nursing homes once she has spent down, looking/asking for a bed.

If she is not safe to be alone, call adult protective services and get them involved. If your loved one has some resources (spend their funds) and hire an elder care lawyer licensed in your state to help you navigate this. There are many rules and steps. There also is something called the "5-year look back" provision; whereby your State Medicaid folks will look back 5 years at all your LO's financial transaction to assure that assets of any type were not hidden or pass to others which is a violation of the "look back" rules and may disqualify you LO from getting Medicaid coverage for a period of time.

Good luck with this.
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Momloveshelp May 2023
Thank you so much for your answer, it was informative and thorough, please keep them coming you sound like you know what you’re talking about and we all sure can use them.
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She has dementia and should be in a memory care facility.
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Cant go to skilled nursing on dementia diagnosis alone. If your loved one can still perform ADLs (activities of daily living) dressing bathing feed themselves) they can't go to skilled nursing. If your loved one is a veteran reach out to them ,they have programs for dementia vets,if not call your local department of aging and the alzheimer's association. These organizations have advice resources to help you care for your loved one.hope this helps
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Jo/ann29, while Medicaid--if you qualify--pays for long-term care, Medicare does not, as others have stated. If you don't qualify for Medicaid, then you have to pay out-of-pocket (until you qualify for Medicaid, if ever). I think you've given this same explanation yourself to other posters in the past?
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if you go on medicade and have a house it goes to the state for reimbursement at death. medicare does not provide long term care. medicade can provide long term care within the home. it takes 3 months to apply. call your county dept, of aging.
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Agree with BurntCaregiver. Follow her advice if you want to get her placed in a facility. Sometimes unfortunately you have to play a little dirty and fight a little bit to gain access in our system. If she needs 24 hour care and can't be left alone, then the way you get her into a NH is make it clear to the social workers that she is unsafe at home and doesn't have someone with her to safely take care of her all of the time. You need the original Dr who said she needed 24 hr care to sign off on that as well. Please note, Medicare won't pay for long term care, she would have to apply for Medicaid. Not regular Medicaid, but long term care or nursing home Medicaid.
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If she's doesn't have a permanent physical disability or serious ongoing health issue/illness that requires medical care, she is mostly a candidate for MC. LTC is for people who are bed-bound or with a profound illness or injury. A doctor needs to medically assess her to need LTC. Medicaid in most states helps to pay for this level of care (plus her SS benefit).

Based on what info you provided, she doesn't seem likely as a candidate for LTC.
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You may need to speak to APS (Adult Protective Services) in the area your mother lives in. Explain to them that she is unsafe at home and alone. Tell them that she has no one to help her.

Talk to the local police too and ask them to do wellness checks on her. They will. If the cops see that she's not coping they will get things rolling on getting her into a facility though APS. Faster than you will be able to.

Then there is the last resort. The 'ER Dump'. This is when you bring her to a hospital ER and ask for a 'Social Admit' because there is no one in the home to meet your mother's care needs and that you are not able to. Then ask to see a social worker. They will send one down to speak to you and you tell them this. DO NOT let yourself be talked into taking her home.
The hospital will make all kinds of promises of resources and homecare help if you take her home. None of it is true. DO NOT take her home.

She will be admitted to the hospital and they will keep her there until they find her a bed in a care facility. Hospitals have endless resources and legions of social workers. They will be able to find her a place a lot easier and sooner than you will be able to.
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Caregiverstress May 2023
This is my plan when it comes time to place my father. He is impossible and will never agree to go into care, or admit that he needs any help as he thinks he is fine. A very difficult personality type. He just turned 82. Alpha, a screamer, won’t stay out of his car (we are working on a plan to have the car “stolen”) but he demands that people jump to his every need and can get very angry. His dementia is still in the middle stage (they say he has ALZ but I suspect vascular dementia as all of this was triggered by a stroke). He’s good some days, awful on others. He lives alone, but his girlfriend is there on the weekends and his friend is staying temporarily in the in law apt under his house. I manage his finances, have listed his cabin for sale, and am working on shutting down his business to get the commercial space sold all behind the scenes. He screams at me and tells me to stay out of it, so I enlist others to help me and do what I have to do without him even knowing I’m doing it. Eventually there will be an event that I will use to trigger placement. He wanders into the bank to try to take out money (they know what’s going on with him as I have spoken to the bank manager and they won’t let him take out more than $200) but he gets there and has no idea how to get the money out, so they walk him through the process. I took his debit card so he has to fill out a slip. One day he started screaming at a teller because he was getting so confused. I told the bank manger the next time that happens to call the police. At some point something will happen that will land him in the hospital and at that point I will say he is unsafe to be sent home as he lives alone. I live 3000 miles away and am his POA and MPOA. I will work with them to get him placed. I have the MC place all picked out. It’s sucks that is has to be this way, but you have few options when dealing with someone who is this difficult. I am not moving home to be his 24/7 caregiver. I see what it does to people. Not doing it.
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Yes, the criteria is 24/7 care and one suffering from Dementia is 24/7 care. My Mom was perfectly healthy other than her Dementia.

They probably think you mean Rehab. I would go to the Longterm facility and talk to them. If you need Medicaid, you need to find a facility that will except it. You need to explain that u no longer can care for Mom and what she needs in way of care. When you find they will except her, they should contact your doctor and get an order.

If not looking for a permanent placement, you call Moms PCP and see if he can order in home therapy. Hopefully, she has traditional Medicare because they should pay most of the bill. A suppliment usually goes along with it. If she has a Medicare Advantage, that may be ur problem. They are suppose to honor A&B but not always. Maybe her Dr will have to get involved.
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