How do I work out with the nursing home my mother's financial problems?

Just a comment to throw out there. I know this won't help with your outstanding bill. But have you considered Hospice for your mom? My mother is at home with late stage dementia and is on Hospice. Moms meds are all covered through Hospice along with her supplies. This has helped so much because my mother doesn't qualify for government help. But my point is that Hospice is just not for patients at home. Alot of Hospice patients are in fact in a nursing home. I am not sure how that works though, Hospice doesn't pay for room and board but pays for Nurses and aides, medications and supplies. So in turn that could help with future bills if any. But talk to the staff.
Another thing, I had a friend that placed her father in a personal care home. His income wasn't able to pay the full amount each month. He didn't qualify for medicaid for the first year there. So my friend volunteered so many hours each week at the home to makeup the difference. She did simple things like help with laundry, serve meals, tidy rooms up etc... So maybe that could be something to ask about.

Thanks, coach, I understand. It's true that I've been hearing about them wanting to slash Medicaid in many states. Ok, I won't begrudge them anymore. Cheers

Bryn, Don't blame the nursing home or begrudge them for trying to be profitable. On average a nursing home makes about $.03 per dollar of income. Taking care of our frail elderly is a very expensive proposition. Today nursing homes are being faced with more and more demands to improve the quality of the care that is provided and in most states are taking care of a much more acutely ill individual. Many sates are slashing medicaid reimbursement to help balance their budgets, but at the same time the Federal government is looking to slash12 to 16% from nursing home reimbursement. Nursing Homes are only trying to work within the framework the government has forced them into.

Both for-profit and nonprofit facilities have to ask "how will we be paid?" before they accept someone. Very few working class people have enough money/assets to pay for their own care indefinitely. Perhaps if you are 98 and you only have enough money to pay for 2 years of care, that is satisfactory. But if you are 78 and you only have assets that will see you through 4 years, the facility is going to need to know what comes next. For many people, what comes next is Medicaid. Because Medicaid has caps on what it will pay for given services, the facility is not going to be taking in as much when that happens. For this reason, many long term care facilities just do not accept Medicaid. Others will accept it only for residents that have private pay for so many years first.

My mother's total income, at age 91, is $850/month. That is it. No savings. No life insurance when Dad died. No 401K, no equity in a house. She had no trouble qualifying for Medicaid. So far that is helping with the few medications she takes, and doctor/hospital bills. She is still living independently in her senior apartment. If/when she does need long term care placement, she will need to find a place that accepts Medicaid; she will not be able to private-pay even a few months. Meanwhile, Medicaid and her county are providing services to keep her home as long as safe and practical. My mother is "poor" by the definition Medicaid uses. Fortunately your mother was not. But she probably would have met the definition if she had needed long-term care for many years. Most of us would. A perfect system? Hardly! Out to victimize those that need it? I don't think so.

Thank you, igloo and coach for taking your time to explain things to me. I am now understanding the whole thing much better. I will get back to you for updates.

Mom has Medicare and Blue Cross Blue Shield supplement that are paid every month. They won't pay for nursing homes after 100 days so when Medicare stops, Medicaid takes over. Funny system, isn't it? Medicare will stop taking out funds from Mom's SS. I took care of Mom in my home for nearly 2 and half years until her Alz's D got worse, she became a wanderer, tried to go outside, falling down. Due to my being deaf I nearly had no sleep keeping an eye on her, had no other help. That was before I found this site. I'd LOVE to take Mom back home instead of having to deal with nasty nursing homes that want profits. Many of them used to be "non-profit".

Jeanne, you are probably right. My MIL had a teacher's retirement and SSDI, which was quite a bit of money. The nursing home wanted to take her, get $6,000 per month from her income, then her savings, then the principle on her 401K, and then the equity on our house. The program, like so many government programs, was intended to help the underfunded. The people who twist the system into something it was never meant to be so they can make money off it are the real problem. We were lucky that my MIL could stay with us under our care until she died. But we did feel that the hospitals and care facilities were trying to rake in all of her money that they could get their hands on, and they offered Medicaid as one way to help them help us help them.

Well, close, but not quite, JonathninOregon. Since Medicaid is a needs-based system, there is an upper limit on how much you can have in assets and qualify. If you have more than that, Medicaid does not take it to offset the costs of care. Rather they allow you spend down to the limit you are allowed. You can spend this on consumer debt, a delux wheelchair, repairs to your home, a new wardrobe, a prepaid funeral plan -- lots of ways to use your own money. You cannot give it away, because if you don't need it for other things, then you are expected to spend it on your care. Taxpayers aren't expected to subsidize your legacy to your children or gifts to others. The cap on assets impacts a spouse, but not children. You do not have to be broke before your mother will qualify. The home is exempt from being included as an asset, but by the same reasoning that doesn't want taxpayers to support legacies to heirs, the proceeds from sale of the house can be used to pay back Medicaid for expenses it paid.

I am glad for you that your mother was too wealthy to qualify for Medicaid, and that you were able to meet her needs in your home. That really is the ideal situation, isn't it? For the many, many people who do not have the ideal situation, Medicaid is a rescuer, not a victimizer.

As I understand it, here's how Medicaid works. First, it takes all of your mother's assets to offset the cost of her care. Then it empties your bank accounts and puts a lien on your house to pay for yor mother's care. Then, after you and your mother are both broke, the American Taxpayer will cover the rest of the costs associated with your mother's care. Medicaid sounds great until you get plugged into it. My MIL opted to die in our home rather than bankrupt her legacy to my wife. It was hard, but she successfully avoided falling victim to Medicaid. Good Luck. God Bless You.

Your Mom was admitted to the Nursing Home on April 24th. Under Medicare your Mom was entitled to 100 days of care as long as she required what Medicare deems as skilled care. She apparently received her 100 days of Medicare and exhausted her Medicare benefit on August 1st. As she obviously did not have the funds to pay privately the nursing home put her in a Medicaid Pending category while they waited on the Medicaid approval. It is customary for the nursing to request a prorated amount of her Social Security check. In this case it would have been prorated less one day. How did you think the Nursing Home was going to be paid for the month of August for caring for your Mom as you already stated you had anticipated Medicaid approval as of September 1? I am sure the Office Manager attempted to explain this to you as she seems to be very aggressive when it comes to collecting money. Which is her job. I think the problem here is a lack of communication. The nursing home, under ADA, should have used the services of an interpreter to communicate with you. The nursing home accepted that responsibility when they agreed to admit your mother. They should also use the interpreter during mandatory care plan meetings. Of course you will be responsible for letting the nursing home know when you plan to be there to discuss your Mom's bill or her care or any other time you would like a formal meeting. I would say that you should provide no less than 48 hours notice. If you don't provide this notice, you should not expect an interpreter to be present. Remember the Nursing Home is going to be paying this interpreter $60.00 to $80.00 an hour. Most services require a 2 hour minimum once scheduled and have to be paid if you show up or not. They don't come cheap so please don't abuse this service.

Thank you so much for taking the time to provide this update. Experience is the best teacher -- and it is great if it can be someone else's experience. :) You got some ideas from other posters and now you are returning the favor. I hope that your caregiving journey gets less bumpy and that having your mother close will be pleasant and convenient.

I forgot to add: that check in amt. of $322.00 from SS to refund Plan D. I thought that it was business office that arranged it, but it just happened that they reduced amount from 52.00 per month to $5.70. Just a coincidence! So it means more money owed back from Plan D even if it'd be small. I am bit confused in all of this.I will ask Social Security office tomorrow when I call them.

Update!!

That lady at business office at that nursing home where Mom is was very nasty to me last Wednesday night. In front of other people in front desk! She demanded that I gave her 3361.00 right away. When I told her that I couldn't do that she got mad, said that I was stealing money from Mom's SS checks, threatened to turn me in to Social Security. I told her to go ahead! Due to my deafness she wrote me a page full, but grabbed it & crushed it before I could finish reading it so I left.

Next morning (thanks to this website) I called Ombudsman via relay service for Arkansas. Turned out she happened to have a deaf son & knew what I went through. She was very helpful. I told her the full story. She told me to go ahead and give nursing home a check of what's left of Mom's money in her bank from SS which is $1116.00. That Ombudsman lady in Little Rock said she will get in touch with Ombudsman in my area which is Hot Springs.

I emailed to Julia, an Admin. of Alzheimer's unit where Mom is & told her that I would not deal with that lady from business office, that I would now require them to provide me a certified sign language interpreter according to ADA (they'd have to pay for it.) I told Julia what I used Mom's money for, that I had paid for Mom's Blue Cross Blue Shield in advance for 3 months, that Medicare and Plan D took out money, etc.

I also requested to Ombudsman for a transfer for mom from that nursing home to the one close to me which is 5 min. away. She said that it would be so easy since Mom already had been approved of Long Term Care Medicaid which is transferable.

Anyway, to my surprise I got a check from Social Security office in amount of 322.00. It's a refund for Plan D (Prescription Drug Plan.) Got a letter from them.

How do I get refund from Medicare that still takes out 96.40 per month? I thought business office took care of it. I will call Social Security via relay service tomorrow to ask about it.

Amount has gone down from 3361.00 to 1923.00 so far. Still more to come from Medicare and Blue Cross Blue Shield (supplement to her Medicare) which will help more. Then the rest I will have to come up with from my own pocket.

To answer coach's question, Mom was admitted to nursing home on April 24. Medicare paid for it until July 22. I got confused, thought Medicaid would start to take Mom's SS checks in September when she was approved, but it goes back to July!

Again, warning: the moment Medicare stops paying Medicaid owns SS checks already, not later when approved. This was my mistake.

How long has your Mom been in the Nursing Home. Was she admitted in late March or early April??

Coach is spot-on, There are really 4 issues here:

1. From the month she is accepted into Medicaid, her resources less whatever her state deems as monthly personal care allowance - which varies from $ 30 - 60 a mnt - all must go to the nursing home. SO if she has 800 SS & 1000 retirement
then $ 1,740 - 1,770 must go to the NH from the month she gets there. Some NH will prorate the first days to the actual date but don't have to if they take privatepay.
Sadly that means the $ you spent on other things for her you shouldn't have and it should have gone to the NH. If you signed her into the NH AND signed your name rather than "Jane SMith as POA for Ann Smith", then you signed off as legally responsible for the debt. Which did you do?

2. If her monthly medicare payment is being deducted from her SS - that amount is usually paid by the state if she is poor enough. This is about 88 a month - this can take 1 - 12 months to get resolved as the $ for it comes from different state resources. There is nothing you can do to move this if your state is slow on this reimbursement. So she will be in a minus catagory for that amount. The NH know this but again if they are not a non-profit, this can become an issue

3. If she has a supplemental insurance policy, like BCBS, that is automatically taken from a retirement account then that is usually exempt from being included in her resources. It depends on each state how this is viewed. You may have to write to have this reviewed/appealed. While it is under appeal, the NH cannot enforce billing you for the outstanding difference under federal compliance with the state run Medicaid program. Must be in writing

4. Filial Responsibility - 30 of the 50 states have filial responsibilty laws, which means children can be responsible for the debt of their parents. It's based on old English law from the 1600 & 1700 when there were still poor houses. Now most states that have "filial" on the books have it written weak and it is not enforced. But a couple of states have NH that use the law to "encourage" family to pay for NH charges. This has happened in Pennsylvania with actual judgements against family members.

I bet your mom's NH is for-profit and views every action from meds ordered to physical therapy as a profit center for them (through companies they own) so the $ they get for Medicaid for her room & board is just the start of what they can bill.
This is totally legal but it is a major conflict in my opinion.

GOOD NEWS: If you are just on SSDI then you are judgement-proof, That means that whatever they try to do to you legally they have no real recourse as the $ your get from SSDI cannot be seized. Not that this keeps you from getting collection letters as collection agencies are pretty ruthless.

My bet is that you will get the 30 day letter from the NH - which means you have 30 days to move her out or they will turn her case over to the local agency on aging or Medicaid ombudsman. This usually shakes $$ out from family. But in your case the $ isn't there. The NH doesn't know that. You need to let them know that in no uncertain terms.

Since you are disabled, I'd go to the meeting with a short letter saying you are not responsible for your mom's debts, you are only her POA and doing your best aftercaring for her for 2 years, that you do not have any disposable income as your only have SSDI. That the only option you see is for them to get paid over time by payment from the personal needs $ your mom gets every month to pay down the debt - say 50% of her personal needs allowance. If they are willing to accept that, then fine and you want it in writing. Also take a good friend to the meeting to listen & take notes for you. Good luck.

Then I'd still move her closer to you once that opens up.

Medicaid decided how much of your mom's income will be considered her responsible portion to be paid to the nursing home. It is not the nursing home who makes this decision. Normally, if you are your mom's poa medicaid will send you a letter explaining what your mom is responsible to pay and when she was to begin paying it. You can appeal Medicaids decision, but it is extremely rare that they reverse a decision. Regardless the at this point the nursing home is due this amount as Medicaid will reduce what they pay the nursing home by this amount.

Sorry I don't have better news, but that is how the system currently works.

Contact the social worker you already know, at the hospital and explain you'd like to ask some more questions about your mother's case. See if you can start there.

Yes, I used her SS checks to pay for expenses of her house and her attorney fees plus things she needed like shoes (therapist's advice) to make it easier for her to walk, they were expensive, underwear, socks, robes, etc. Outings and gas expense for me to drive back and forth to see her (I see her 4 times a week and also take her home with me for her overnight stay on Saturdays.) I think it's a good idea to talk with a social worker at that nursing home, but I haven't met her/him so I don't know who. Only a social worker at hospital in behavior health unit before she was transferred to a nursing home. She was excellent!

You are not responsible for your mother's expenses. I think at issue here is that you had control of her SS checks. The nursing home claims you should have paid them with those checks. You used them to pay other expenses of your mother's. Is that correct?

I think yellowfeever is on the right track. If Mom has a case worker or a social worker who helped with the Medicaid application talk to that person. Leave your own finances out completely but explain what you did with the SS checks and the situation you are in now.

I forgot to add: I didn't expect for nursing home to claim Mom's SS checks going back to July. I thought they'd start in September. So anyone reading this: be warned that amount of SS check is expected when you apply for Medicaid, not when it gets approved.

I already told that lady in business office at nursing home about Mom's expenses. I didn't discuss mine. She still insists on me coming in Wednesday to give her a full amt. of 3361.00!! So naturally I am freaking out! That amt. goes back to July & consists of 4 months of her SS checks. This doesn't make sense to me. I forgot to add: I paid 551.10 recently for Mom's supplement to her Medicare (Blue Cross Blue Shield) out of her SS money. I can't imagine having to pay 3361.00 which there is little money left. She did say she'd turn account over to collection dept. if I didn't pay this Wednesday.

Since she is on Medicaid, call the wefare office and explain the bill you got. I think that medicaid does back pay a month or two from date of approval. I wouldn't go into detail about financial things in the past. Just keep it simple to what is going on right now. Only discuss her financial business and try not to throw out to much of your financial situation. Because you don't want to be held liable to pay this. . So how can she pay if she has no money. That's how she qualified for medicaid in first place. If the welfare office won't help ask them to direct you to someone that can.