I have a cousin in assisted living and money is about to run out. What will happen?

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KarenU Asked May 2019

I have a cousin in assisted living and money is about to run out. What will happen?

My cousin is in assisted living because she suffered a stroke in 2016. I have helped her with her financial and medical needs since she has speech and memory problems. Long story short, she will be out of funds in exactly 2 months. I have applied for Medicaid for her since Oregon will pay for assisted living but so far she has been unable to qualify due to her evaluation of needs for her care. The assisted living facility isn't helping matters because they aren't giving her the real care she needs because they insisted on at least one years out of pocket funding before she applied for Medicaid. I believe they did this to receive more money for a longer period of time since they knew Medicaid would not pay as much. My problem now is, what will happen when she runs of funds and hasn't qualified for Medicaid. I have read that it can get ugly if she is evicted and I don't respond to go pick her up. My name of course is on the contract because I am the one that found the assisted living facility for her. I am concerned because I may be held liable for payment even though technically she is not my responsibility. With that being said, what will happen when she runs out of money, hasn't qualified for Medicaid and I don't go pick her up? Will Medicaid then step up to the plate?

Assisted Living Medicaid Paying for Care

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score 2 · Answer 1

Medicaid is a federal program that is transferable between states. The trick is to close out the account is the first state before starting in a new one.

Found a great site just today for everything you could possibly want to know about Medicaid.

https://www.medicaidplanningassistance.org/transferring-medicaid

Helpful Answer (2)

It’s not really a “transfer” though. You have to re-apply when you move to another state. My FIL went through the process last year. He had to go down to social services after he moved to California and apply for medi-cal, going through the entire process again. California didn’t just approve him because he had Medicaid in his home state.....he still had to meet our requirements which are not the same as his home state’sz

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score 3 · Answer 2

Will the AL kick her to the curb? Not likely as it’s lousy public relations but they will do whatever to try to get you to come & get her or have you deal with moving her to a different place.

Transfer requirements for those living in AL can be pretty nonexistent as it’s “assisted living” so in theory they should be able to do for themselves with some help. If they are in AL, they are expected to be ambulatory with perhaps some help sometimes. It’s not a NH which means they need skilled nursing care 24/7 & is required by state regulations to provide for safe transfer.

If you've let the AL know that under no circumstances will you be coming to get her, what is likely to happen is that the AL will find some reason to call EMS to have her go to the ER. Like it appears she has had a TIA - transient ischemic Attack- or some other very subjective health care issue. EMS gets her & she is now a problem for the hospital /ER discharge planner to deal with. The old AL will refuse to take her back. The discharge planner (usually a SW) will contact family to see who will come and be responsible for moving her into a new place or take them into their home to live. You have got to be clear & firm that you cannot provide the level of care and oversight that she needs. If they are insisting that it’s your duty as the DPOA, you can say that you’ll relinquish your dpoa to let her become a ward of the state. Yeah, it’s extreme but sometimes it can the best path as a state appointed guardian can get her evaluated & moved into a skilled facility quicker than you ever could. If she has no assets and you’ve been transparent in your handling of her $ as her POA, there should be no repercussions to your relinquishing your POA.

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score 0 · Answer 3

Your cousin needs to be in LTC. No AL is equipped to care for your cousin with all that is wrong with her. Really surprised they excepted her. They assist not do round the clock care. They don't have the same ratio of aides to residents a LTC does. Plus, you took her from one State to another. Medicaid does not go over state lines. Does she need to establish residency in ur state?

Good Luck and come back and update us. We learn from others.

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My cousin has many things wrong but not to the level associated with an LTC. I understand they do not do round the clock care at AL, that's not what is needed at this time. What is needed is for the ALF to do their job, which thus far has not been satisfactory compared to the one she came from in California. As far as establishing residency for Medicaid, that doesn't seem to be an issue. She has lived on Oregon for the last 6 months and has an Oregon ID card.

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score 2 · Answer 4

I think ur SW maybe wrong.

ALs are usually privately owned. They need to have certification to except Medicaid and Medicaid can take that certification away anytime. It happened where I live. Other than the state inspects them, they have no say in what their criteria is.

I found there is a lot of misinformation when dealing with the "sales" person at an AL. Yes, I was told after paying at least two years, Mom could then use Medicaid. What wasn't said was that if they haven't met the % of residents they allow on Medicaid. If they had, she would have to find somewhere else to live.

I think there was some miscommun-ication on the part of the AL. A year of self-pay sounds reasonable.

Now for Medicaid. What do her doctor's reports say. With a stroke does she have a neurologist? Have the doctors orders state that her health is such that she needs 24/7 help and not able to live on her own? That LTC is her only option.

You may need a lawyer to get u thru this and he can be paid with her money. But then she really doesn't have it.

Helpful Answer (2)

After my cousin had her stroke she went to rehab for 3 weeks and only saw a neurologist when she was in the hospital. Other then that she was always seen by her GP. She was limited as to who she could see because she had a Medicare Advantage plan and apparently most Dr's wouldn't accept her. I am waiting for the written discharge papers from the rehab hospital because I remember when I spoke to them after she had her stroke, they said she would need to be in AL. I also spoke to the ALF in California where she was at before coming to Oregon. I asked for their help with this matter because she was having trouble qualifying for Medicaid. They said they didn't know why she couldn't qualify because she needed help because of dementia, 3rd stage renal failure, incontinence, etc etc. Some of these things I didn't even realize. I believe the evaluation given at her current ALF was under scored. She needs way more assistance then what she is receiving. That explains a lot because I couldn't understand why she was failing so miserably at simple daily tasks. This all stems from the AL's neglect of my cousin's state of mind. At one point the administrator told the SW that they didn't know why she did the things she did. They thought maybe she might be lazy or embarrassed. Needless to say I was quite annoyed because that isn't the case at all. If these so called professionals knew anything at all they would know the difference between being lazy and dementia. I am really beside myself but ready to fire a few people up. This is unacceptable and if I have to get an attorney so be it. I am not going to let my cousin fall through the cracks. It makes my blood boil to think that our seniors are being treated as if they have something to prove in order to get assistance and it's all because of low life fraudulent people in our society today. In any case I will get the necessary info. I need and I will prove my case. The fight has just begun. I do thank you for your reply. Knowledge is Power!

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score 1 · Answer 5

Good thing that you signed the contract as POA for her. The facility cannot hold you responsibility. In this case I would contact an elder law attorney. Often, Medicaid decisions have to be challenged in order to be successful. Maybe this is a case of the AL accepting someone that needed more than AL care?

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If this doesn't go my way, then for sure I will seek out an attorney. Currently AL is all she needs.

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score 1 · Answer 6

KarenU, have you asked the social worker for help with this?

So. You have a 76 year old disabled person living in an ALF. The ALF agreed to take her as a medicaid recipient from September, waiving the extra three months question. So the ALF's issue is with funding for July and August, only?

There's got to be a way through this. You are not responsible for your cousin's care; so looking at her a stand-alone individual, what would the ALF, OHP and the rest of social services do with her if you didn't exist?

Have you tried this page? https://www.oregon.gov/dhs/seniors-disabilities/LTC/Pages/index.aspx

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The AL is upset because I told them upon entering that we could make it until September but that didn't happen. We will be able to pay through July. I'm not sure what is going to happen if she runs out of money and doesn't qualify for Medicaid. I am assuming the state will have to step in because I've already informed them I can't take care of her and will not be picking her up.

(1)

score 0 · Answer 7

Help!!!

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score 2 · Answer 8

If your cousin suffered her stroke in 2016, and the ALF requires at least one year's self-funding before they'll accept her as a Medicaid resident... how long has she been in the ALF? Where was she being cared for before? What was agreed at the time of her admission?

I've got the phrase "Medicaid pending" buzzing around in my head but I'm afraid this really isn't my subject. Fortunately there are some past masters on Medicaid on the forum, and I'm sure they'll have helpful information for you.

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She was in assisted living in California before I moved her to Oregon where I currently reside. The ALF I applied for in OR are the ones that required this but I found out from the social worker that is technically an illegal request. She has been here since Dec. 19, 2018. I told them originally that she would only have funds through Sept. and then would be applying for Medicaid. They then agreed to take her. Since that time my cousin has run into expenses for dentures and oral surgery which has now exhausted a good portion of her funds and she will be out of money by the end of July. Medicaid is having trouble qualifying her because they feel she is too independent but that is not the case. She couldn't possibly live on her own based on the problems resulting from the stroke. I have racked my brain explaining every possible disability she has but it's still not enough. I feel like she would have to be a vegetable to qualify. This is very concerning and stressful to me and I only want the best for her because she is my closest living relative but at the same time legally she is not my responsibility. I don't know what the right answers are to qualify her for Medicaid. They keep probing me, thinking I might say the right thing to make this all work but so far no luck.

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score 2 · Answer 9

I feel that you need information from an eldercare attorney. This person is your cousin and to the best of my knowledge, you do NOT, under any circumstances or for any reasons have to come up with YOUR MONEY, nor provide living space for her. This is the cousin's problem - not yours. Get some good doctors to evaluate her and help with her "care needs". Stand firm, you are not going to provide money and you cannot care for her. Rest assured, and I don't know who or where, but she will go somewhere - that is the law. They can't just put them on the street. Do NOT give in to any demands from anyone. You are NOT responsible.

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I am afraid the assisted living facility will hold me liable for payment when she runs out of funds because I am the one that signed the application for admittance. I signed my name POA for her name.

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I have a cousin in assisted living and money is about to run out. What will happen?

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