Has anyone had issues with a nursing home mishandling trust funds?

Original poster

I worked in LTC for over 25 years and most of the residents were medicaid. To my knowledge any of the $ ( under 2 grand) was in the relatives hands not the facility. If the families came and visited ( wasnt always the case) they may have brought them some needed items. All SS checks went straight to the finance office from what I was told. I am an RN so I really wasnt involved in this but my SW friends filled me in on the facts......

In discussion with the snf, the Trust is supposed to insure the patient/resident will not be forced to go without very personal items - like toothpaste and clothes. These are basics that Medicaid does not pay for. Non-emergency medical transport from snf to a doctor's appointment is a legitimate use of the money. If the resident wants cupcakes and coffee (for him/her self only) it's supposed to be made available for that purpose.
Barber/beauty shop, books & magazines, houseplants, Christmas decorations, are some other examples. I think non-Medicaid covered co-pays for any drug or medical service can also be paid for out of a trust fund.
If the resident wants cupcakes, is he/she allowed to buy a dozen to share with others or only one (a la cart) for him/herself? I wonder if Medicaid or snf decide if the resident can share a box of 24 cards w/friends or family.
Maybe this is a gray area.
My second point of understanding is when it comes down to brass tacks, the government i.e. Medicaid/Estate Recovery hopes to have some funds in this trust account as it will be paid to the state upon death of the patient. If more than the $2,000.00 accumulates in the trust that can be an issue with Medicaid.
My objective would be to coordinate money-in/money-out so the fund never accumulates over $50 - $100. A lady at the snf said when Medicaid recertification begins, the snf must report to Medicaid how much money is in the Trust fund. I'm still trying to learn the ins/outs so I will know how to conduct business. It's not fair that families are left to their own devises to try and figure it out.
The OP really has legitimate requests as far as I'm concerned - unless the contract states items purchased must be inspected. If services are obtained on the economy - like out-of-pocket co-pays that aren't covered by Medicaid, or a sandwich and cola at Subway, the only proof that can be submitted is the receipt/invoice for those services and goods. The doctor and the patient can't demonstrate to the snf what is listed on the receipt/invoice. It would be a cold day underground if a doctor and Subway manager had to be present to verify a receipt. So, again I'm sensing there are grey areas when it comes to snf trust funds. Maybe the snf arbitrarily sets it's own standards for what is appropriate if it thinks too much money is being spent or if it is concerned about the amount that is actually in the trust fund at a given point.
If anyone else knows more about this or why the OP really had problems getting the money back, I'd like to have a firm grasp on this issue.

Most places require inspection of items brought it..Its policy # 1 and in your case your are asking for reimbursement( dont blame you). I dont understand why they have the trust in the first place? I have never heard of that. Please inform.

Original Poster.

Sorry - what is the OP?

People, the OP has not returned to clarify. Either a Troll or a misunderstanding.

Who requires it? Medicaid or the nursing home?

So far, information conveyed to me is the trust fund is required if Medicaid is involved. If Medicaid requires it, the brightest bulb in the pack is the government.
I hope whomever is charged with holding the funds, it should have to account to the patient/family/trustee immediately or as soon as the next business day. Maybe such a policy is in place at snfs.

Maybe they are stealing the money from the trust fund. Who was the bright one that named the nursing home as trustee?

Even though a change in policy may have happened it sounds pretty arbitrary. I visited a facility that said refunds can be issued Mon-Thurs for anything that fits within the criteria of "personal needs" - up to the amount of money actually in the trust at the time a receipt is presented. They did not have any list of items that were and were not considered acceptable. It sounds like the facility may be doing an after-the-fact CYA because someone mis-spent somebody's funds. This could have been staff or family. I would make copies of receipts for items purchased because once they have your receipts it would be harder to prove. I would ask why they suddenly changed policy.

OP has not returned.

Demand an itemized account of all deposits and withdrawals with day 1 as the start date of the PNA, should also show a penny or two of bank interest added. An up and up NH should be able to print this for you in 10 minutes or less!

No, No, No. A residents PNA, Personal Needs Account is just that....PERSONAL. It is normal for phone, cable, or haitdresser to be taken without family or resident, depending on papers signed upon intake. However, since it appears the NH is not giving you an itemized account of the funds and it's balance, there may be something shady going on. Your family member can spend her money, cuz it is her money, on whatever they want, be it clothes, lottery tickets or $200 worth of chocolate. If there is a medical reason about the clothing, such as a wool allergy, I can see, but it sounds like you have been given the runaround. You can also set up an outside bank account, not to exceed $2000 to keep the majority of the allowed amount, and only give the NH enough to cover the standard, cable/phone/hair. Let the NH that you are not the person to be messed with and know the rulea and regs. Threaten them with media, call ombudsmen, call Medicaid and report your suspicions. Medicaid may even audit the entire facility if they suspect fraud..if it walks like a duck...you know the rest.

No, the NH did not let my mother stay there that long. She was told she was too well to stay there...less than 48 hrs later suffered an ischemic stroke there.

What state are you in? Here in Virginia, medicaid nursing home residents sign over their SS to the NH. You are allowed only 50.00 a month for yourself. You can have no more than 2,000 in your checking account. Medicaid clients dont have much $$$$.

Just a question, how did a nursing facility become her trustee when there is family.

Hello

I wish I knew which state you live in. The fact that you are the Legal Guardian means you should be getting a copy of all expenditures from her trust on a monthly basis. I again cannot tell you how much money is acceptable in her Trust. What I can tell you have the right in your legal status to request a full accounting from the nursing home. If this is happening to you what is happening to those residents unable to check their finances on their own.

And just so you know I have been a Legal Guardian. This responsibility was placed on you by court order and because of this you will need to account for all financial transactions. It is better to get this under control now. If you still are not sure call your attorney or call Justice In Aging (look up number by Google or email them).

Why on earth wouldn't her child be in charge of her money
/affairs? Somethings is very fishy here. Get to a lawyer immediately before they try and cover up their records. Always save your receipts and label them what you bought. Moms "trust" will pay for the lawyer so get there ASAP.

I'll have to agree with the "get a lawyer" sentiment. While we live in IL and not a nursing home per se, our executive administrator has taken to making rules and announcing these in general meetings. No paper is ever sent to the residents. You are expected simply to comply whether or not you were able to attend the meeting. It's an unfortunate part of learning to age that you also have to afford legal assistance. No one else's word seems to have any meaning to the people who run these places.

Go straight to the administrator of the nursing home & find out what's going on. Then let him/her know that you will be going to the state with your attorney to see if what they're doing is legal.

You'll get results.

Ken,

1. As Igloo asked, specifically what kind of trust is this? What's the title of it (leave out names, just explain what it's titled)?

2. Who's named as Settlor - your mother? Is there any issue that she might not be cognizant to revoke the Trust?

3. Who are the Trustee(s) and successor Trustees?

4. What are their SPECIFIC roles?

If they've breached the specific terms of the trust, there may be a cause to terminate it for breach of fiduciary capacity. This is an issue for an attorney to help you with. If the nursing home's law firm drew up the trust, which I suspect, absolutely do not contact them or ask for help.

Find your own independent counsel who works for you.

everyone's Medicaid amount may be different depending on what they have or their spouses expenditures. my father can keep $2400. its always good to get the advice of a good elder attorney, the cost is worth making any mistakes or being taken advantage of.

Is mom on medicaid? So that the "trust" you refer to is actually her personal needs allowance (PNA) that is held at the facility to pay for incidentals not covered by Medicaid? The $ is in a PNA "trust" and not a traditional drawn up by a lawyer trust or a true Special Needs Trust?

If so, Medicaid rules do NOT require for the residents monthly income to go directly to the NH. The resident can still continue to have their bank account and get their SS & retirement income go into their bank account & then they or their DPOA can write a check for the exact copay or SOC to the NH. The copay amount will be in the eligibility letter from Medicaid. Their bank account will increase by whatever your state has its PNA each month. (Like for my mom in TX it was $ 60 a month.) If you do this, you must be mindful that the bank account cannot be more than 2K as 2K is the asset limit for medicaid. So if mom had say $ 1,500 of assets in the account when she initially applied for Medicaid, after a few months, she will be over the limit. So it will need to get spent to be under 2k always.

They do not have to have a resident trust account at the NH. It is really a convenience for resident, DPOA & the facility to have one. What they are used for is for weekly beauty /barber visits and if there is a canteen or store at the facility. My mom used her PNA for beauty shoppe each week and to buy candy & when the scout troops came to buy cookies or popcorn. I kept it at around $ 200 and NH sent a statement on it every 90 days.

If NH is telling you it's being debited to pay for mandatory cable, or phone, you as DPOA can decline that mom has those under Medicaid rules. This seems to be a commom ruse for NH. If NH is telling you that mom must have her monthly income sent to them, that is flat not true under Medicaid rules. If they are telling you mom must have a PNA trust that they hold, that is not true. If you live in moms city and are active in her life, there could be no need ever for use of a PNA trust at the NH as you can easily pay the hairdresser, do her clothes & toiletries shopping, etc. Hell, if mom is still ambulatory, you can take her out to shop either on your own or on a field trip done by activities director of the NH.

If you as DPOA pay the SOC, the NH may press on you to personally sign off on a contract to pay or contract on late fees.......you don't have to do this if they are on Medicaid. But if the check is late, they can place a late fee which you personally will have to pay as Medicaid won't.

For those whose elder is on medicaid, DPOA keeping control of funds can be really important IF you should ever want to move them from 1 NH to another NH as getting the whole direct deposit changed could be very difficult to do if your elder is very demented and cannot do whatever required for changing SSA or retirement .

If this is private pay, then however the admissions contract reads is what can be done. Review all pages of the contract for that situation.

Can anyone explain why a nursing home would ever be named trustee of a trust?That seems so strange to me. What assets would have been put in such a trust and why would that have been recommended by a lawyer?

I would suggest first speaking with the Administrator of the facility. I do understand the facility's need to document the items actually were for your mother's use. However, you should certainly have received a written notice of the change in policy in advance as well as when you turned in the receipts.

Yes get in touch with your states ombudsman and find a good lawyer.Allot of lawyers no days make the abuser pay the lawyer fees.Then proceed to find a better nursing home.Let the state step in and they will guide you through the process .There is no excuse for this.It is financial abuse.Have you all documented records? Receipts etc ,timelines etc.I worked in a place that had one book for the state and the real one locked up..unfortunately for the abuser the families knew about the locked up book and wooosh the person went to prison...do not feel guilty for taking action,you will save allot of people allot of turmoil.they will tahnk you

not sure if too late now however anyone who is putting their loved one in a nursing home, you should never sign everything over to the nursing home for them to pay out of your loved ones funds. someone should have advised you to take the funds, put into an account and have the nursing home send you the bills to pay for your mom and then YOU pay the bills and give the payment to the home. This way they have to provide you with what they are doing and what the money is being used for. Get in contact with an Elder attorney right away. wishing you luck.

Don't mess around with the "kids" of the nursing home----GO RIGHT TO THE TOP with your questions----do it in the form of a elettter----print it out as well as send it through the net and send it......nursing homes are subject to government inspections and rules and laws.....let them know you will take action to "them". Find out which government body you can get ahold of that will take action.....these homes don't want trouble and many of them do run "just on the fringe" of being legal in some cases.....Good luck-----I've had to be the squeeky wheel for my Mother too and they do stand up and take notice......if they can shut you up on the "first floor" they'll do it----they get nervous if they know you'll go to the "top"

Get in touch with the local Ombudsman- they are there to help mediate problems like this one. Maybe even just taking that step will help the nursing home rethink their new "policy".
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