Is there a difference in care if you spend down assets in the nursing home as opposed to being on Medicaid when you enter?

My mother went in NH as private pay and transitioned to Medicaid when the money ran out. She remained in the same room with same care throughout. Our family was always convinced that none of the workers knew which resident paid which way

My daughter says no and she is an RN in NHs. She says the aides are not prevy to who is and who is not on Medicaid.

But Medicaid requires 2 to a room. Even private pay is 2 to a room unless u want to pay extra for a private.

The best strategy is that when she is close to needing facility care, to find a really good, reputable one that accepts Medicaid and have her enter it on private pay. This way when she qualifies she, as an existing resident, has first dibs on the Medicaid beds there. If she isn't in a facility when she goes onto Medicaid then she may be subject to waiting lists, depending on what state and city she lives near.

For my MIL, who went from private pay AL in a great facility, is now there in LTC on Medicaid. There's been no difference in the qualify of care she receives. It's been an awesome place.

FYI in the vast majority of facilities being on Medicaid means a shared room. So maybe you can ask this question before selecting a facility. Some good facilities have waiting lists just to get into AL or MC on private pay.

I suggest discussing things with either an estate planner or a Medicaid Planner for her state so that you know what to do and expect. Don't make any assumptions about it. Whoever is her FPoA needs to be extremely careful and transparent so that they don't inadvertently disqualify her. Most states' Medicaid financial app has a 5-year look back. Medicaid in most states only pays for LTC, which means she would be basically immobile and bedridden or profoundly ill needing a lot of daily medical care. Just because she has ALZ and needs MC doesn't mean Medicaid will cover it in her state. Knowing this and other details will help with the planning and save a lot of headaches and surprises later on.