Can an AL facility deny a person based on a quiz of a few questions?

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Tajann Asked September 2023

Can an AL facility deny a person based on a quiz of a few questions?

Mom had enough funds to pay private AL through end of September. We met with Elder Law Attorney last week, I am now her POA and the Medicaid waiver is in process. So far, medically, she qualifies. The rest is in process. The lawyer said the money that was stolen (and given) this past year will not affect Medicaid as she was technically paying "her dues" for shelter and food living with her older daughter. Mom does not want to pursue charges as oldest daughter does not have ANY money to pay back, hence the reason mom was giving her money. That is now a moot point.

Another issue, we toured a Medicaid waiver facility and they said mom did not do well on the memory test. Anyone who went through the following would have trouble with a test at this point!

1) She is grieving over the loss of her 41 year old grandson who tragically died and she was very close to.

2) Has a history of severe depression

3) Traveled 800 miles in a car after staying in a hotel for 7 days because granddaughter removed her from AL out of state

4) Had not been taking medications due to the above

So all of this will affect memory but mom does not have dementia. In any case, the executive director is going to meet with the DON to discuss having mom back for a reassessment. Mom does not have dementia. At the private pay facility, she is in an apartment on her own, bathes, toilets and dresses without any assistance. She uses a walker and wheelchair (for long distances) and is unable to stand for long periods of time to cook or prepare meals, so she has 3 cooked meals a day and a nurse administers her medications. She not only sees a primary doctor regularly, she also sees a psychiatrist.

Can an AL facility deny a person based on a quiz of a few questions? Do they not require a medical diagnosis before denying someone?

Assisted Living Diagnostic Criteria Medicaid Paying for Care

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score 1 · Answer 1

Oh I am so glad it worked out for her.

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score 1 · Answer 2

Tajann, what wonderful news! So happy for both.

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score 2 · Answer 3

AL are businesses, and what they want is someone who functions well and who can pay full fees for as long as possible. After that (and if you are lucky) they can find a Medicaid unit, if the person is still going well. It sounds as though your mother can only afford private pay AL for a short time, and will then be looking for a Medicaid bed. That is likely to be more of a problem than whether she has an assessed dementia.

It might help if you find the AL’s own rules and also any Medicaid rules that apply. You may feel angry about how this is working out for your mother, but you can’t force changes in either set of rules.

Helpful Answer (2)

Mom was accepted into a new AL facility and passed all memory tests. She is doing quite well and her apartment is much larger than where she came from and less expensive! The residents seem happy and the food is great!

(6)

score 1 · Answer 4

They can deny anyone for any non-protected reason (race, gender, etc). They're a private organization.

Why would you subject her to that test with all those issues going on?

An AL is not a memory care facility, and they have every right to know if a prospective resident had dementia. What do you think a medical diagnosis would entail? (Hint: They'd give her the same test.) Memory issues are not diagnosed with a blood test.

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I am happy to say, Mom was transferred to a new AL facility, passed all "memory" tests and is doing quite well in this new community.

(1)

score 1 · Answer 5

Tajann: I am glad that she is going to have a reassessment that hopefully will give her an opportunity to do well on.

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Thank you for your kind response! She was able to do a reassessment at a different AL community and passed all memory tests. Getting much needed rest does wonders for the brain!

(2)

score 5 · Answer 6

Whether or not the ALF is guided by ANY rules will really depend upons whether or not it does accept patients and receive governmental funds for them. You seem to indicate this is an ALF that is accepting Medicaid. Therefore there may be some rules and regulations; ask them. Normally, however, most ALF and MC facilities are private pay and they DO have a say over who they accept and on WHAT level of care they accept them. And yes, as you can imagine they do cherry pick. I would imagine we all would if we had our own facility and free reign. Giving someone who needs MC or maximun psychiatric support an ALF room may have repercussions on the rest of the facility clients. I know firsthand what level of angst happens when ALF folks see an inappropriate placement of a senior.

A letter from your Mom's MD may help. And yes, testing is difficult to ALL seniors, for certain; anxiety is the norm, not a rarity.

I sure do wish her good luck and am glad about the retesting.

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Mom is currently in a private pay facility. We are looking at facilities that accept Medicaid assistance, what she brings in from social security and a small pension is not enough to cover private pay facility. Mom does not have dementia. I am a registered nurse and have worked with patients who have dementia. Untreated depression and situational anxiety, along with insomnia can absolutely affect any type of mental cognitive testing.

(1)

score 1 · Answer 7

ALs are private businesses. They are limited in the kind of help they can give. My Moms AL excepted those suffering from Dementia but I now see where more and more MC units are being added on. AL residents usually just need some kind of assistance. Some still drive. I find more and more with MC popping up, ALs will not take those suffering from Dementia because there is an option. So this AL has the right to evaluate and turn a person down.

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I don't believe a Medicaid approved AL facility can make that decision. I do believe a diagnosis given by a psychiatrist or a neurologist is required to confirm any type of dementia. Which they have not asked her to do. I plan on consulting with her psychiatrist next week.

(0)

score 6 · Answer 8

Sadly it's been proven that people that have a history of chronic depression are much more likely to suffer from dementia, so I certainly wouldn't rule that out with your mom, as she very well could have it.
And being in denial over it won't help her one bit. Instead have her tested by a neurologist if that would make you feel better and then start looking into the appropriate placement for her even if that means memory care.
You must do what is best for her in the long run.
Best wishes.

Helpful Answer (6)

I am not in denial. I am a registered nurse with almost 17 years of experience, I've worked with patients who have dementia. Mom has severe depression, which went untreated while staying with other daughter out of state. She has now been on a strict medication regimen and doing very well. The cognitive "test" she took 2 weeks ago does not reflect the norm for her.

(1)

score 0 · Answer 9

seems like they should be medically examined... geriatric evaluation

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score 7 · Answer 10

Dementia presents in many different ways. I don’t agree that the harrowing things your mom has been through would cause anyone memory problems.

It’s good that she can have a reassessment, and I wish her luck.

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Can an AL facility deny a person based on a quiz of a few questions?

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