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I have a mom with moderate stage dementia who is in independent living with home health 6 hours a day. she is in spend-down and we are going through funds quickly. she needs more care and best would be memory care. She is not yet eligible for Medicaid and I cannot have her live with me. I have talked to state, county, and many facilities and have yet to find a place that will accept her due to financial limitations. Have not yet explored the 8 bed and fewer AL homes due to concern about quality of care she will receive. I am her primary caretaker / POA and burned out - still working as well. We are in DC metro area. thoughts?

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I used CarePatrol in my area . They are a franchise of care advisors.. not sure if they will be able to help because of the Medicaid situation. But it may be worth the phone call….My moms memory care required 1 yr self pay , which she did not have . Because of the business relationship of my care advisor and memory care , they took my mom…
you don’t pay them , they are paid by the facility with placement
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Theo951 Jul 2023
Thank you. My wife called them today and the advisor couldn't answer for other areas. Offered to refer advisor in another state but the question we're trying to find out is WHICH STATE doesn't require upfront self-pay. We know 2 yrs is required where we currently live but the advisor recommended calling Medicaid for further answers.

Do you happen to know if the 1 yr your mom's memory care required was a Medicaid policy for your state or facility specific?
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The major "problem" is that most facilities that will take Medicaid will do so after a person has been private pay for sometimes 2 years or more.
So ideally the thing to do is to get her into a memory Care facility that accepts Medicaid NOW so that she will spend down funds making her eligible for Medicaid. Then apply at that time.
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One thing to note about the two year private pay for then takes Medicaid. Make sure you get it clearly stated in writing that after those two years they will switch to Medicaid. Many facilities that have that clause fail to mention they have limited Medicaid beds and it is on a wait list. So you are still responsible for if no Medicaid bed is available after those two years.

This is the issue we ran into with my mom. Our family was willing to cover the cost for two years but no facility would guarantee that after those two years they would take Medicaid no matter what, and since I would be the guarantor none of us wanted to be left with that bill.
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SharonMarcie Jul 2023
Thank you Abzu00. What did you end up doing?
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Sharon, I would check the board and care homes, aka 8 and under ALs. Even if they only have 1 caregiver it is still a smaller patient to caregiver ratio then any large facility has.

I placed my dad in one and I highly recommend them.

Obviously, as with ANY facility, advocating is crucial, as is moving her if your 1st choice isn't living up to its agreement and taking good care of mom. Make sure the contract is month to month and doesn't create a long term bill even if she moves or dies.

This is a difficult transition, so don't worry if you don't get it right the 1st time. Go put eyeballs on each facility, listen closely to the sales pitch and form questions from all the information you get. Ask as many questions as you need to feel comfortable, if the buck take there name outta the hat.

One thing to specifically ask, do they keep the residents through end of life and hospice. Not all, even huge facilities, allow hospice and it is a terrible time to be looking for a facility.

Best of luck. This is a tough time for all of you. May The Lord give you guidance, strength and wisdom for this time.
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SharonMarcie Jul 2023
Thank you lsthisrealyreal. i will be more open and explore some of the smaller facilities.
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Get a social worker involved. Contact your local Agency on Aging first to see if they have a SW to help with you and mom. How much time is there until her money runs out? You are going to want to apply her for LTC Medicaid (nursing home Medicaid) as soon as her bank account is under the limits set by DC. It is very difficult for you to place someone with no money in a MC Unit or NH on your own. You can keep trying, but if you have no success you are going to need help from a social worker. They will not allow an elderly person with dementia to be a danger to herself. Do not quit your job and take her in with you. (unless that is what you really want and feel the need to do, it is your choice. Just take some time to fully comprehend what that would do to your overall health, emotionally, financially, and physically). You do not have to, and you need to make that clear to the SW. The SW's generally have the ability to fast track and find a suitable location much faster than you could, although it may not be at the facility of your choice.
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SharonMarcie Jul 2023
Thank you Mstrbill. I tried to get a SW with the county in MD she lives in but with no luck. The Agency on Aging was not helpful. I literally cannot take her in because I have a 2 floor condo and she cannot take steps. I really appreciate your response. Perhaps I need to find some other kinds of agencies that have SW that may be able to assist?
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Thank you Grandma1954. So far, none of the places we have talked with will take her due to her limited finances. She does not have enough to pay for 2 years or more at full price which ranges from 7 - 12 k in the DC area. It's a sad state that our country does not take care of our elderly. I am so scared and started looking into LTC insurance for myself. It is cost prohibitive and I make a decent salary.
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Theo951 Jul 2023
Do you want to say what state?
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How can we find out what states don't have that 2 year pay requirment?
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I'm looking for more detail on the 2 year pay requirement people posted about. Does anyone know if this is a state to state difference in Medicaid program requirements? Or could it be a difference in the policies of privately owned ALF's which might be found in any state? I'm trying to determine why it's not "universal" like one post mentions.

We are flexible to relocation if it would behoove us and relatives. If it's an ALF policy difference, then relocation wouldn't make a difference. If it's a state Medicaid requirement difference, then does anyone know a convenient way to find out what state's don't have this requirement? Calling Medicaid offices in every different state would be onerous.
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Theo951 Jul 2023
*Onerous = My wife spent half the day trying to reach local Medicaid office to ask more questions about this for our state. After several tries she finally got a live person on the line who couldn't answer anything. They transferred her to an extension with voicemail saying leave your question and we'll try to get back to you in next 72 hours.

There has to be an easier way to find out what states don't require a term of private pay first. (a list?)

That's all we're looking for at present. I'm abroad on assignment. My wife and our parent's, uncle are home (U.S) and we'd like to start contemplating different locations if it would benefit us to move. Thank you.
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Try Tribute at the Glen in Woodbridge VA.
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Another resource may be your county office of aged and disabilities

i live in Wisconsin, the one year requirement was established by the facility, I believe… there was more selection of places that took Medicaid with 2 and 3 year self pay.. care patrol placed my in laws where there was no requirement for self pay…
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