My 84-year-old great aunt has cerebral palsy and recently suffered an accident that caused her to need 24/7 care, but Medicare won't help.

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SBoyack Asked April 2020

My 84-year-old great aunt has cerebral palsy and recently suffered an accident that caused her to need 24/7 care, but Medicare won't help.

My great Aunt has been living in a wheelchair for a while now but has been able to live on her own with assisted help on the weekdays. But she suffered a bad fall on a saturday night about a month ago and wasn't found until her caregiver arrived Monday. Because of this she can now barely move, the most being lifting up her arms a bit. She can't even move her neck. Her closest family, my mom and aunt, live 3 hours away with no extra room to take her in. We were hoping Medicare would help pay for a nursing home in our city so we could be closer to her but because of a new law put into place, they can only pay for people who are both physically and mentally unable to care for themselves. Since, my great aunt passed the mental test with shining colors they won't pay for it. Hospice care said they can come in the mornings Mon - Fri but that is all they will do. My mom can try to be with her every other weekend but can't be there during nights on weekdays because she has work and young kids who basically need to be homeschooled now because of the schools currently being closed. My other aunt applied for loan to try and hire someone who can be their weekends and weeknights but since the US is already low on healthcare workers because of COVID-19 it seems it'll be a while before we find anyone who can help. My great aunt needs 24/7 care but we are quickly running out of options. My family doesn't know what else to do. Any suggestions will be greatly appreciated.

Long Term Care Medicare Paying for Care

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score 1 · Answer 1

Something is super confusing or missing here.
Medicaid is not dependent on whether the person meet the criteria you state (OP). That’s not how it works.
Medicaid helps poor people with no financial assets.
OP maybe you are applying for something else but are getting wrong information from someone?

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score 1 · Answer 2

SB, someone needs this person to see that "as of October " reg in writing. She has to qualify medically for NH care, but you do that by getting her medical records and talking to her doctor about what forms and assessments need to be completed.

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score 0 · Answer 3

That's insane, it doesn't make sense. What if one had ALS (Lou Gehrig's disease) where the mind is perfectly fine? How would that person survive in Texas once hi/her funds dried up and had no one to take care of him/her? You mean to tell me the State of Texas wouldn't take of that person? Again, you need to call APS or consult with a good attorney.

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score 1 · Answer 4

Please read this link: https://www.nolo.com/legal-encyclopedia/when-medicaid-texas-will-pay-nursing-home-assisted-living-home-health-care.html

An appeal should be filed asap.

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score 1 · Answer 5

The Area Agency on Aging is charged with doing "needs assessments", i.e., determining what level of care is needed. [who did the "needs assessment before she was discharged?]

APS needs to be contacted because if she is truly in need of 24/7 care, they will take her into care and get her a bed in a facility.

WHO told you that she didn't qualify for Medicaid?

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Barb, OP said "Medicare"; maybe she doesn't realize the difference.

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score 3 · Answer 6

OK, since she's home now the option would be to call the state social workers or adult protective services and report a vulnerable adult. If she needs 24 hour care and is not getting it they need to step in. I also think there is still some misinformation here. Medicaid does not turn someone down because of mental competency. If one physically needs skilled nursing, Medicaid will cover the costs if 24/7 nursing care is medically necessary and patient is unable to pay. You and your family do not have to pay your resources for her care. Call APS and get someone who knows the ins and outs of the system to advocate for your great Aunt.

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We live in Texas and have been told that of October 1st, Medicaid is required to take both Physical and Mental tests and if the patient passes in if them they cannot pay for their care.

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score 2 · Answer 7

Medicaid only turns people down because the patient has enough funds to pay themselves. There is a limit...I think it's $2000. If you have less than that, then they will help you. Let's use my mom as an example. She cannot use Medicaid until she spends down her $150,000 savings. Once that is gone, then Medicaid will step in and pay for her care in a nursing home.
There are too many unanswered questions in your post for us to help.

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We live in Texas and Medicaid has told us that of October 1st, they are required to take both Physical and Mental tests and if the patient passes one of them, they can't pay for it.

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score 2 · Answer 8

She wasn’t denied Medicaid because she’s mentally healthy—that has absolutely NOTHING to do with Medicaid eligibility. If she was turned down, it’s because she isn’t financially eligible. Are you getting your information third hand? There seems to be a lot of confusion and misinformation.

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Thank you for pointing out my error in reading that, Worried!.

For Medicaid LTC, she needs to be both financially and medically eligible. Who is looking at her eligibility?

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score 2 · Answer 9

Did she apply for long term care Medicaid? Who says that they turned her down because she was mentally healthy? Do you have that in writing or is that aunt's interpretation of what the decision was?

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The OPs great-aunt didn’t apply for a loan. It was another aunt that applied for the loan, not the great aunt that fell.

(2)

score 1 · Answer 10

She went to rehab and should have become a long term resident there as a private pay patient until she spent down her assets to a Medicaid-eligible level.

If she has the wherewithal to take out a loan, what she has in the bank should be used to pay a facility (much less expensive than full time home care).
Social worker should have explained this better to the patient and to the family.

Getting an eldercare attorney is one way to deal with this right now.

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score 2 · Answer 11

Something doesn't make sense here. Did she go to the hospital? I'm assuming she did. Did the hospital discharge her with no one to take care of her? I can't imagine they would have done that. If they did you need to contact APS ASAP and have them look after her, but they shouldn't have discharged her to a situation where she wasn't taken care of. In fact contact an attorney if that is the case. It sounds like great Aunt needs to be in a SNF for rehab which Medicare will pay for a period of time. Then, if she needs to stay, she needs to pay on her own if she can while planning for LTC Medicaid when her funds are exhausted. If she has no funds now she needs to apply for LTC Medicaid.

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I forgot to mention this part of the situation but yes, she went to the hospital and was admitted to rehab which was paid for a limited amount of time. But since we couldn't afford to pay for extended stay they had no other option but to send her back home with hospice care.

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score 2 · Answer 12

It’s Medicaid that pays for nursing homes, not Medicare. Medicare pays for rehab but only 20 days at 100%. Hospice doesn’t provide home care, they provide a nurse to check vitals and order meds weekly, and they provide a home health aide who comes out to bathe the person. It’s up to the family or hired caregivers to provide the round the clock care. Instead of applying for a loan, your aunt needs to apply for Medicaid if your great aunt isn’t on it already. Medicaid will either pay for the nursing home or for home care BUT they won’t pay for round the clock home care so the family will either have to step up or hire additional aides & pay them.

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score 3 · Answer 13

Medicare does NOT pay for long term care; this is not a recent law.

Did great aunt get admitted to a hospital after her fall? If she was in the hospital for 3 midnights, she becomes eligible for REHAB paid for by Medicare if her doctor orders it. There is an initial benefit of 20 days, paid in full (if she progresses and cooperates) and an additional 80 days with a co-pay of about $170 per day, usually picked up by supplemental insurance.

Has aunt applied for Medicaid? Have you contacted the local Area Agency on Aging? You can contact Adult Protective Services. Have hospice services been started?

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Yes, she was admitted to the hospital and went into rehab but we couldn't afford to keep her there for an extended period of time. We did apply for Medicaid but because she is healthy mentally they turned her down. Hospice care has been started but they just come in the mornings Mon - Fri to bath her. What can the Area Agency on Aging and Adult Protective Services do to help?

(0)

My 84-year-old great aunt has cerebral palsy and recently suffered an accident that caused her to need 24/7 care, but Medicare won't help.

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