Friend in nursing home needs therapy, but facility says they won't pay. Any advice?

What a complicated situation! I think quite honestly that there isn't a whole lot YOU can do to help. The Mom and the son, it sounds like, are going to both need some POA or Guardianship by family; if there is no family able or willing, then by the state. I am actually surprised you are getting as far as you are already with information given you, unless it is all coming from your friend herself.
If she has funds for it she might request a visit from an Elder Law Attorney. I can't imagine you, yourself, can get very far in this.
I surely do wish her luck. This is a tough situation to be certain.

Robin, LTC Medicaid in my understanding is hard & fast regarding copay of mo income to NH. Exceptions for community spouse or preexisting dependent. Dependent status can look at past tax filing status (which you said likely wasn’t) or there’s guardianship done - like grandparents who adopt or named guardian for their drug addled or incarcerated kid kids; OR elder is really older dad & has kid from likely younger wife or ex wife. For dependents & SS, payment ea month till 18 based on elders / parents SS & paid separate from elders SS$ retirement income.

If NH resident wasn’t (before going into Nh) drawing her own retirement SS, I don’t think any of this matters. Like it works for a 75 yr old grannie legal guardian for grandkids 7 & 10. Kids can get SS dependents benefit paid based on grans SS award as she’s guardian. I’m pretty sure this is accurate. But this situation is not what you’re describing. The mom is not herself on retirement based SS, right? Son lived with mom for years; is his own person, but not self supporting & relied on moms income to cover his living costs. He’d be out of funds without her SS$ that she should copaying to NH. The copay is not, I’m guessing, not going to be waived to him; he’s probably not legal dependent of hers. He’s got to either to get a job & be on his own & pay all his living costs including her mortgage & house costs OR live on whatever SSDI will pay. Living in mortgaged house days supported by Bank of Mom are over with imho.

To me, having a mortgage is a deal breaker on EVER keeping a homestead once LTC NH Medicaid involved.
4 different fronts on this -
- Medicaid is required to attempt a recovery of all costs paid from her estate. House will be asset of estate. Just how estate recovery (MERP) runs is interdependent on states laws for probate & property rights & how administration code runs for Medicaid. There are exemptions & exclusions to MERP (like disabled heir) but all need to be filed for & with documentation after death. It’s paperwork heavy, you have to be tippy top in detailed documentation on costs since Medicaid started & beyond death. There seems to be oodles of cockups so far... I don’t see him or her being able to do what needed now & him in future to deal with MERP. Unless you are going to make this your new full time project till whenever.
AND
- some states allow for predeath lien on property that basically is a placeholder for Medicaid. To sell or transfer, lien must be satisfied. It’s an unsecured debt so MERP gets $ after mortgage (secured lending) is paid. I think NJ is a predeath lien (Tefra) State. If so, there’s a lien it property already, it’s subterranean but there.
- the required Medicaid copay must be paid. Mom will have no $ to pay mortgage. So either son, family or friends or you pay mortgage. If not, will be foreclosed on. It’s rare that someone will pay another’s mortgage till whenever knowing that they may not ever actually acquire it.
- house has costs..... taxes, insurance. Mortgage requires taxes & insurance paid. If not, mortgage can call in loan. Maybe can folded into redo of mortgage for higher payment, but will trigger a Review of credit worthiness. Not gonna qualify & Medicaid lien will show up in title search. Foreclosure. Whomever paid mortgage has no real recourse to get $ back from sale.

NH if there’s an outstanding bill and she/son have ignored notices, can file a lien on the property. Ability to do this will be in admissions agreement. Could be this has been done & why NH seems to be rather blithely ok with her not being current on the copay.

Keeping home can be done imo if empty or existing living in home elderly sibling or disabled heir; NO MORTGAGE; costs 1 or 2 always in agreement heirs or occupants can afford till forever; heirs have pretty solid shot at MERP exemptions. & makes sense to them & their wallet.

unless you will front $ for all for her, the house, her son, best idea is JoAnn’s. She knows of what she speaks!

The problem lies in the fact that there is no one to pay the skilled therapists. The therapists need to get paid for their work. Normally Medicare or LTC Medicaid or private insurance is billed for the hours of provided skilled therapy, the therapists are paid from them, not from the nursing home. But in this case there seems to be no one to bill, and the therapists are not going to work for free. They are like sub contractors, not direct employees of the NH. If she was approved for LTC Medicaid, it is a requirement that the entire SS check less a small monthly allowance ($60 or so) gets turned over to the NH. If that requirement is not met, I'm not sure what the legal repercussions are nor am I sure if the therapists or NH gets reimbursed for their care.

Medicaid needs to be made aware of a disabled son living in the home. Her SS must go towards her care. It is included in the cost of her care. I doubt if she'll ever return home if not accessible.

I bet the NH did the application, right? I bet Medicaid was not told a disabled son was living in the house. If they had been aware things maybe different.

I would talk to the Social Worker at the NH. Ask if they aware of the son and he needs Moms money to live.

Has anyone checked on the son to make sure he has what he needs? I ask because this happened to a woman who was taken out of the home by the Health dept for an infected foot and Dementia. They left the challenged son behind. He keeps in touch with me. I was able to get a caseworker involved and he is now in the same NH as Mom. Hopefully, they will find him a group home eventually.

Sounds like she is on LTC NH Medicaid.
& imo & to be blunt, her getting “therapy” isn’t the solution.
There’s bigger issues in this scenario. Imo unless you are her DPOA & MPOA with legal to clearly establish that, whatever your being told by her or her disabled son or even staff likely is inaccurate. Due to HIPPA regulations, facility can’t share her health status or Medicaid eligibility or basically anything else unless your a POA. And your not, are you?

If she went into NH after a hospitalization & amputation surgery, then she entered NH as rehab patient w/mediCARE paying if she was over 65 or whatever health insurance she had if under 65. MediCARE pays rehab benefit & coverage can go to 100 days, other insurance companies tend to follow Medicares lead. Rehab 20/21 days standard for “broke a hip” scenario. I imagine rehab post amputation would be lots more time. She could have stayed rehab as long as “progressing” in care & up to 100 days. Info would be in her health chart.
BUT
Once she stopped progressing, or noncompliant rehab, or hit 100 days, then a decision was made as to if she could have a safe return home. Whatever needed to happen for her, the son or family / friends to show she could leave NH & return home did not happen. She transitioned from rehab patient to LTC resident. If it’s been a year, she might show in her chart be evaluated to be beyond being ambulatory, she now considered “bedfast”. If so, PT, OT, ST cannot provide services. Sadly this might be what is happening. Facilities aren’t apt to not do PT or OT as they can be paid by some combo of Medicare or Medicaid or other insurance.

Based on what you wrote, Medicaid application was filed so she’s either “Medicaid Pending” status or has been approved. Could be SW did one that she signed off on or APS was asked to intervene & did file one. If she’s refusing to do her copay or is being noncompliant for care, I bet there’s documentation as to lack of cognition & competency in her chart. Which can morph into other problems.

Regarding her monthly SS income..... what’s the status on the son, is he able to live independently? Is he a legal dependent of hers with tax filings that show this? Or living in her home & using her income to cover their household expenses? Does he have his own income? or is he on his own “at need” program? Answers are super important as LTC NH Medicaid REQUIRES her to do a copay or SOC (share of cost) of basically all her monthly income (like her SS$) to the NH unless there is a spouse or legal dependent. That’s the rules for Medicaid.

She is going to have to turn SS$ over 1 way or another unless a spouse or legal dependent. NH can file to be the rep payee; APS can seek for court to do ward of the state status on her; or NH can send her or whomever is her DPOA a 30 Day Notice to have to move out. NH to me is being pretty patient if this has been going on for months, but eventually that will run out. Could be something is already in play on her for rep payee or ward action. If it’s 30 day approach, they won’t kick her to the curb but likely will find a reason to call EMS to take her to the ER & then NH will refuse readmission based on not being able to provide the level of care needed for her situation.

Please try to see if anyone is DPOA for her and talk with them regarding your concerns. If there’s not one, you can pay for an attorney to file guardianship & if your appointed, you then can take over her financials, get her NH billing issues resolved, go to her care plan meetings, move her into your home & deal with whatever inhome care her state actually will provide, or move her into another NH, or onto hospice, and you can deal with her sons needs as best you can, sell her home if she has one, and you contact the court every few months with the required guardianship paperwork by the state. Maybe 5-10k to do a guardianship & you better have a spotless credit history & no legal issues in your household.

Yes, there are different kinds of Medicaid. Institutional Medicaid assumes poverty. I am not being sassy. I am being a realist.

If son is disabled in some way, he needs to be in touch with social services to obtain his own entitlements.

H sunnygirl. She was not on Medicare. She will be this November when she turns 65. She is not cognitively impared. When she came to the facility she was waiting to here back from her Medicaid application (she had no insurance). They cannot legally discharge you if you are waiting to here back from medicaid. They also stopped providing therapy because she had no way to pay, but they didn't kick her out because that would be illegal. Like I said, I guess they have to keep you, but maybe they can get away without providing therapy. As far as I know, her Dr. was still recommending therapy continue. Isn't allowing her to wither away like that neglect? Once she got Medicaid, it back paid for all the time she was there. I would anicipate medicaid is paying the full amount minus her 1500 dollar check, since they are insinuating that they cannot do therapy without the extra money. As I said before this insurance has a provision for people to be able to provide nursing level care in the person's home, so caregiving wouldn't be an issue provided that she is able to stand to transfer from one room to the next (wheel chair too wide). Her son, although not physically able to do everything, would also be there for moral support.


She and her late husband paid their share of taxes for many many years so I don't think it's fair for anyone to imply that she is "taking advantage". Paying "her share" means losing her house and her son being homeless. If she has no house to return to than all this is pointless. Since being in this facility she has also had multiple bladder and kidney infections caused by them not coming to clean her after urinating and defacating, which has been documented. She has gone many days without clean clothes when they don't her laundry on time or "lose" it. She also has had her HIPAA rights violated many times. There was one instance when one staff member was shouting out in the hallway using her full name and saying that her brother sounded like an alcoholic and calling her a b word. So they are not angels in this situation. I guarantee the percentage of the monthly cost for the bed they receive is much more than their costs for her care. Btw Barb, there are many different kinds of medicaid, and many people who are on medicaid do have an income. I didn't come here for sass or judgement. I came for advice on how to get her the therapy she needs with the understanding that she needs to be able to pay her mortgage for her son to have a place to live.

She needs to pay her Social Security to the nursing home to help pay for her care. Disabled son needs to get his own disability income.n

The question is if the disabled son is eligible for assistance. Has he or she plly for him disability such as SSI, SSDI, through Social Security?

Sounds like a messy situation for a skilled social worker. Disabled son needs her income to live but Nursing home also wants her income. I don't have the answer but I would hope somebody with some authority to take control of the situation to satisfy the needs of the Son, Mother and NH at the same time would be available. Not sure where to direct you, maybe Social Services or Legal Aid? APS maybe?

Is your friend cognitively challenged or is she able to understand how that process works?

It's my understanding that the rehab would have been covered by Medicare (if she's on Medicare) for so many days after her entry to rehab. So, if she was not able to leave after that who has been paying?

Is it possible that PT was stopped due to lack of progress?

Plus, if she can't stand, she can't leave with no one to care for her at home. I recently observed a family friend who's husband was in rehab and they (I think the social workers) would not authorize his release because there was not a proper ramp, bathroom or caregivers in his home! I'm not sure how that worked out.

I think you need to try to talk her in to paying the nursing home what she owes them. Her social security check is her share of cost. Right now Medicaid aka the taxpayers are paying her way. The term beggars can’t be choosy comes to mind here.

Or perhaps find out if she has Medicare and a supplemental that might cover PT in a skilled nursing facility?

So, why should the NH do ANYTHING for her if she won't pay them?

Medicaid is for folks who are destitute. If she has other funds, or insurance, she can pay for her therapy.